Acne scars are permanent textural changes and indentations that occur on the skin as a result of severe acne. The term “scarring” is used for the temporary red and brown marks and uneven skin tone left early after acne has occurred. These marks will always improve with treatment.
In severe acne, large pus-filled spaces known as acne cysts are formed. These cysts destroy skin tissue which is not replaced during the healing process. When the cyst eventually empties and the area heals, it usually leaves behind an indentation or scar or in some cases raised and lumpy known as keloid scarring
Acne scars fall into two main categories: those caused by a loss of tissue (atrophic scars), and those caused by an excess of tissue (hypertrophic scars). Within these categories, there are four main types of acne scars: ice pick, boxcar, rolling, and keloid scars.
Ice pick scars are deep, very narrow scars that extend into the dermis. The skin looks as if it has been pierced by an ice pick or sharp instrument. Ice pick scars develop after an infection from a cyst or other deep inflamed blemish works its way to the surface. Skin tissue is destroyed, leaving a long, column-like scar.
This type of scarring causes rolling or wave-like depressions across otherwise normal-looking skin. The skin itself looks uneven and rippled. Rolling scars develop when fibrous bands of tissue develop between the skin and the subcutaneous tissue below. These bands pull the epidermis, binding it to deeper structures of the skin. It is this pulling of the epidermis from within that creates the rolling appearance of the skin.
Boxcar scars are round or oval depressions with steep vertical sides. Wider than ice pick scars, boxcar scars give the skin an uneven, pitted appearance. This type of scaring develops when an inflammatory breakout destroys collagen, the tissue is lost. The skin over this area is left without support, creating a depressed area. Boxcar scars can be superficial to severe, depending on the amount of tissue lost.
KELOID OR HYPERTROPHIC SCARS:
Hypertrophic/ Keloid scars are a more severe raised, scar that grow above the surface of the skin and grow larger than the original wound and can continue to grow long after the original wound has healed. Some people are more prone to developing keloids as it can be hereditary. Hypertrophic scars are more common after a deep wound or trauma. Keloid scars develop due to an overproduction of collagen.