Understanding of Acne Scar Types is important before ne can decide which is the best mode of treatment.
There are a number of Acne Scar Types but can be classified into groups.
In general, there are two categories of acne scar. Those that cause deficiency of tissue is called atrophic scar. Those cause excess of tissue is called hypertrophic scar. Within these categories are four different types of scar. There are the ice pick scar, rolling scar, Boxcar scar, hypertrophic or keloid scar.
When the Acne Scar Types is a rolling scar:
Here the scar is shallow and its edges is slopping gently imperceptibly with the surrounding normal skin. Such scar in general is easier to treat.
The scar comes around due to the inflammation of subcutaneous tissue. The fibrous band of scar pulls the epidermis down toward the deep skin. The pulling within the dermis creates the unevenness of the epidermis giving it wave like undulation appearance.
The treatment of choice is by subcision.
When the Acne Scar Types is an ice-picked scar:
Here the scar is small but very narrow and deep just like the hole in the ice cube after it is picked by the sharp iron rod. Such scar is very difficult to treat. The causes is due to infection of a cyst or deep blemish that work its way up from the dermis into the surface. Upon healing of this column of tissue it causes scaring and thus ice pick scar.
Treatment of choice is to use a scar punch to punch out a small, narrow strip of scar tissues vertically or perpendicularly to the skin surface, called punch excision. The resulting hole is approximated by using a small suture such as 6 ‘0’ size.
When an acne scar types is a boxer scar:
This type of scar is having the edges similar to the ice picked scar. It has a sharp edges like the staircase system. The bottom of the scar is wide but is flat, depressed. The shape of the outline of the scar is round or oval. The issues with the treatment is to smooth out the edges by means of shaving a tiny part of the normal skin away.
The treatment is by punch excision, elevation of scar by means of filler or by resurfacing laser treatment.
When an acne scar types are a keloid or hypertrophic scar:
The scar results from collagen over production versus the other three types where all of them have lost of tissues. The scar over grown the original wound. Keloid seldom occurs in the face but always on the chest and the back, some time on the arm.
The treatment is by cortisone cream or tape, or by triamcinolone injection. Interferon injection helps to soften the scar.
Summary of different types of acne scars as shown.
|Ice Pick Scar||Boxcar Scar||Rolling Scar||Keloid/Hypertrophic|
· Deep, small, narrow hole in the skin
· Looks like huge pore
· Extend to dermis
· Skin looks like pierced by small deep, sharp instrument
|· Round/oval depression
· Vertical edges
· Size wider than ice pick scar
· Pitted appearance
|Wave like undulation over skin||· Raised, firm mass
· Grow larger than original wound
· Found in body acne, back, chest
· Face seldom keloid
· After infection of a cyst
· Deep inflamed lesion working upward to the surface
|· Inflammation cause collagen lost in dermis
· Overlying skin lost support, becomes depressed
· Can be superficial/deep depend amount collagen destroyed
|· Fibrous band between skin & Subcutaneous
· Band pull epidermis binding it to deeper skin
· The pulling from within creates rolling appearance
|· Over production of collagen
· No tissue lost as in the other three
· Punch excision & sutured closed
· Punch excision followed by Punch grafting (and plug the hole, then stays suture), from behind ear as donor site.
|· Punch excision (or > vertical edge, trim edge away) of the edges only, followed by elevation of the floor & sutured closed
· Dermal filler
· Laser resurfacing to even out tone or soften the lighter new scar
|Subcision (sub cutaneous incision)||· Cortisone cream, tape, injection to shrink, flatten
· Interferon injection to soften scar