How do acne scars form?

Acne is an inflammatory condition of the sebaceous gland follicle. Not every inflammation causes a scar. With many pimples restores the skin without leaving a permanent mark change in the structure lags behind.

When inflammation is deeper in the skin takes place or remains present longer, can more of the surrounding tissue become involved. During recovery damaged tissue is broken down and rebuilt. Collagen plays an important role in this.

When during that healing insufficient new tissue is formed, can a deepened or atrophic acne scar lag behind. It actually becomes too much scar tissue formed, then a can hypertrophic scar or keloid to arise.

That is an important distinction: Not every acne scar penetrates the skin. Some scars actually to lie above the skin surface.

Atrophic acne scars: the well-known pits after acne

We call the well-known pits and indentations after acne atrophic acne scars. Part of the scar then lies lower than the surrounding skin.

Especially with light falling at an angle across the skin falls, these structural differences can become much more clearly visible.

In the dermatological literature, atrophic acne scars usually divided in three main types: ice-pick scars, boxcar scars and rolling scars. In practice, however, it is a long time not always so neatly divided. I regularly see multiple types scars simultaneously in the same skin.

Ice-pick scars: narrow and deep

Ice-pick scars his narrow and relatively deep acne scars. On the skin surface, the opening can be very small, while the scar continues further into the skin.

They can look as if they were made with a A fine point has been pricked into the skin. Precisely because of that narrow and deep shape do they behave differently than broader, more superficial scars.

A treatment for a superficial acne scar works well, therefore gives not automatically the same improvement with a deep ice-pick scar.

Boxcar scars: wider pits with distinct edges

Boxcar scars are usually wider than ice-pick scars and have more clearly defined edges.

They can be relatively superficial, but also lie deeper in the skin. The breadth, depth and sharpness of the edges determine for an important part how much the skin structure has changed.

Precisely within this category can the differences are significant. A superficial boxcar scar may therefore require a different approach then ask for a significantly deeper copy.

Rolling scars: an undulating skin structure

Rolling scars are usually broader and less sharply defined. This can give the skin a wavy appearance. or acquire an uneven structure.

The remarkable thing is that these scars sometimes barely noticeable in uniform light, while she by light that from the side Suddenly, a lot falls on the skin become more clearly visible.

With some rolling scars, connective tissue strands under the scar play a role. The scar is then pulled down, as it were.

That is also important to recognize, because not every treatment is the same has a point of application.

Can you have multiple types of acne scars at the same time?

Yes. I even see that regularly in practice. On one cheek, for example, a few deeper ice-pick scars are present, besides superficial boxcar scars and a somewhat wavy structure by rolling scars.

That is exactly why one standard treatment for acne scars is actually too simple a thought. It can sometimes be more logical to have different to combine techniques or treatments to deploy one after the other.

Raised acne scars: hypertrophic scars and keloids

Not every acne scar is a dimple. Acne can also raised scars cause.

In the case of a hypertrophic scar, during wound healing too much scar tissue formed. The scar is formed as a result above the surrounding skin surface to lie, but remains in principle within the boundaries of the original damage.

A keloid can continue grow than the original area of the inflammation or damage.

These scars can be after acne for example occur on the jawline, chest, shoulders and back. Predisposition to hypertrophic scars and keloids vary from person to person.

The distinction from an atrophic scar is important. With a Deepened scar is localized tissue lost In the case of a hypertrophic scar or whether there is indeed a keloid of excessive scarring. So that does not automatically apply. the same treatment.

A red or brown spot is not automatically an acne scar.

This is something that I in practice A lot of confusion about it, see. After a pimple, a flat red or leave a pink spot behind. Extra can also occur after an inflammation. pigment develops, resulting in a a brown or darker spot remains visible.

When the skin surface at that spot is simply smooth, is especially the color changed and not the structure of the skin. So that is something different than an atrophic acne scar.

A treatment for a dimple does not need the best treatment to be for a red or brown leftover spot.

Read more about red and brown spots after acne →

Can you camouflage acne scars and residual spots?

With acne scars, not only pits or depressions can be visible, but also red, brown, or other color differences. With medical camouflage therapy can you temporarily make suitable color differences less noticeable, for example, while your skin is recovering or when you do not want a treatment yet.

Camouflage does not change the structure of the skin: an ice-pick, It does not fill in boxcar or rolling scars. Also with With raised scars, the relief remains present. However, a suitable Color correction helps to reduce the contrast with the surrounding skin. In case of active acne or skin that is still recovering from a treatment, I first assess which products are suitable and when you can use them safely.

Read how skin camouflage works for redness, pigmentation spots, and scars →

Why the type of acne scar determines the treatment

The first question for me is not: Which treatment shall we perform? The first question is: What do I actually see in the skin?

Is the surface texture particularly irregular? Is there a clearer structural defect? Is it one deep scar or a larger one? skin area? Is there still active acne? And do I also see redness or pigmentation?

Only then does it become interesting to look at to look at a treatment. At Medicadermis can I, depending on the skin condition including microneedling, TCA and use ResurFX for various aspects of acne scars.

Microneedling: primarily focused on texture

With microneedling, very fine needles controlled microchannels created in the skin. The recovery reaction that follows stimulates, among other things, the production and reorganization of collagen.

I use microneedling mainly when I the texture of the skin want to improve, for example at a irregular skin surface and for that suitable superficial to moderate deepened acne scars.

View the microneedling treatment →

TCA: controlled chemical skin renewal

TCA works differently. In this case, with trichloroacetic acid controlled chemical reaction generated in the skin.

A TCA peel can cover a larger area skin area are used for more intensive skin renewal. With certain acne scars, can TCA is also very focused and local. be applied.

Which application is useful, depends on, among other things, the type of scar, the depth and the skin type.

ResurFX: remodeling of the skin structure

When the structure of the skin has changed more clearly, can fractional Laser treatment is becoming interesting.

At Medikadermis I work with the Lumenis ResurFX 1565 nm, a non-ablative fractional laser. The laser provides controlled microscopic thermal treatment zones attached to the skin, with intact tissue in between.

This creates a recovery and remodeling process in the dermis stimulated. I use ResurFX therefore especially when I am stronger on the underlying skin structure wants to work.

View ResurFX for acne scars →

Compare microneedling, TCA, ResurFX and treatments for residual spots →

Get active acne under control first

When there are still regularly new deep inflammations develop, I am not only looking at the existing scars. It makes little sense to scars only to treat while at the same time new inflammation develops those scars again can leave behind.

Depending on the skin can skincare, clean out thoroughly, peelings and for that suitable inflammatory acne M22 IPL part are part of the treatment process.

In case of severe acne or rapid scar formation can assessment and treatment via general practitioner or dermatologist be important.

Read more about treating acne in The Hague →

Can old acne scars still be treated?

Yes. An acne scar becomes not after a certain time suddenly untreatable because it has existed for years.

More important are the type of scar, the depth, the skin and individual wound healing. Also previous treatments and skin type play a role.

That is why I prefer to speak about the improve of acne scars than about the whole removing it. A completely smooth I cannot promise skin.

For suitable scars can have more even skin, where the pits, floors and transitions become less noticeable, could be a treatment goal.

Frequently asked questions about types of acne scars

What types of acne scars are there?

Atrophic acne scars become usually subdivided into ice-pick, boxcar and rolling scars. Additionally, after acne, can hypertrophic scars and keloids develop. Those last two are elevated instead of deepened.

Which type of acne scar is the hardest to treat?

That depends on the depth, shape and the skin around it. Narrow, deep ice-pick scars can, for example, to a request more targeted treatment than superficial boxcar scars. With rolling scars, can underlying connective tissue strands play a role.

Can you have different types of acne scars at the same time?

Yes. Ice-pick, boxcar and rolling scars can at the same time in the same prevent skinIn addition redness and can also occur pigment spots are present.

Are red and brown spots after acne also scars?

Not automatically. When the skin has remained smooth but only the color is changed, there may be a case of post-inflammatory redness or pigment change. For an atrophic acne scar is exactly the structure of the skin changed

Which treatment is suitable for acne scars?

That depends on the type scar, the depth, the skin type and the overall skin appearance. At Medicadermis I can including microneedling, Deploying TCA and ResurFX. With red or brown residual stains can actually other treatments be more suitable.

View medical camouflage therapy for color differences →