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Everything you need to know about types of acne scars

If you have acne scars, you are not alone. Medical studies have suggested that acne affects 34% to 90% of males and 27% to 80% of females at some point during their lifetime, with the peak incidence reported to be between the ages of 14-17 years for females and 16-19 years for males. Although prevalence rates for acne vary among different reports depending on the methodology used for analysis, the bottom line is that acne is a widespread disorder. Crucially, these studies likely underestimate the actual occurrence rates of acne. This underestimation is because the data are based primarily on those patients who attend clinics for acne treatment, with only up to 16% of individuals with visible facial acne estimated to seek treatment from a skin therapist or dermatologist.


A significant proportion of acne sufferers will have some form of scarring to show for it. Medical studies suggest that between 30% and 95% of patients with acne develop some scarring. Importantly, seeking early treatment for acne helps to reduce the risk and severity of acne scarring. With the easy availability of multiple high street/department store treatments that have limited effectiveness and treatments advertised on the TV/internet that are poorly validated, patients often use treatments for acne that are either ineffective or are not correctly matched with the severity of their acne. As a result, their acne persists or worsens, allowing for the additional development of new acne lesions, thus increasing the risk of scarring. One study showed that overall, 16% of patients with acne seek proper treatment. Among those seeking such help, 74% wait greater than 12 months, 12% wait 6 to 12 months, 6% wait six months, and only 7% wait less than three months to seek professional help for their acne.


So you may be wondering, what type of acne scars do I have? Well in this blog post, you will find out about each kind of acne scar with pictures to help you discover the answer. A scar is defined as ‘‘the fibrous tissue that replaces normal tissue destroyed by injury or disease’’. Causes of acne scar formation can be broadly categorised as either the result of increased tissue formation or, more commonly, loss or damage of local tissue. The bottom line is that the amount, type, and depth of scarring are dependent on the location, nature, and intensity of your response to skin inflammation caused by P acnes bacteria.


There have been numerous attempts to classify acne scars to standardise severity assessments and treatment method. Unfortunately, there is a lack of consensus in the medical literature regarding acne scar terminology and classification. The rating system frequently used in clinical practice for acne scars is based on both clinical and anatomical features. Acne scars have been classified into those involving tissue loss (atrophic) and those that produce tissue excess (hypertrophic). The major types of atrophic scars are ice pick scars, rolling or superficial scars, and boxcar or depressed scars. So far, why particular types of atrophic scars develop as opposed to others is not known. The table below summarises the most commonly used acne scar classification system:


Classification of Acne Scars

Scar Type Clinical Features Comments
Ice pick Narrow (<2 mm), deep, sharply marginated epithelial tracts, and conical or cylindrical shape They often resemble a large, empty pore on the skin and it is these scars that are the most obvious and unfortunately the most difficult to cover up
Rolling (superficial, deep soft scars) Usually wider than 4–5 mm, shallow, anchored to subcutis by fibrosis (subdermal tethering) Rolling scars have rounded, sloping edges, hence the name ‘rolling scars.' They often have a rough texture and a wavy or rippling appearance
Boxcar (depressed fibrotic scars) Flat, u-shaped base; sharply marginated vertical edges; broader than ice-pick scars; round, polygonal, or linear shape; shallow (0.1–0.5 mm) or deep (>0.5 mm) Not to be confused with rolling scars, boxcar scars can appear similar. However, these scars have steep, defined edges and resemble chickenpox scars
Keloidal Raised, excess proliferation of fibrotic tissue, extends naturally beyond the focus of the pre-existing acne lesion Keloid scars are formed when scar tissue forms on the skin in excess, as a result of excess collagen production. Most commonly seen on chest, back, and/or shoulders
Hypertrophic Raised, excess proliferation of fibrotic tissue, remain reasonably within confines of the pre-existing acne lesion Hypertrophic scars are what keloid scars would have been, had the body switched off it's collagen production when the acne wound was filled. Most commonly seen on chest, back, and/or shoulders



To treat acne scars, we recommend visiting our skin therapy room in Chelsea for a free consultation.  Our preferred method to treat acne scarring is skin needling. Skin needling is also known as Collagen Induction Therapy, Micro-needling or Dermarolling. This treatment stimulates the skin to repair itself naturally and safely, by creating controlled micro-injuries in the skin which stimulate the production of collagen and elastin, vital components of healthy skin.


If you live in London or visiting London, schedule an appointment with us. We help our clients achieve their skin aspirations out of a discreet but relaxing setting in Chelsea, London. You can also follow us on FacebookInstagramTwitter and Google+.