Depressed or atrophic scarring consists of three common acne scars which are3:
• Icepick
V-shaped and narrow like an ice pick. It goes deep into the skin and is the most difficult to treat. It is most commonly formed on the forehead and the upper cheeks where the skin tends to be thinner.
• Rolling
Rounded and irregular. It gives your skin a wavy and uneven appearance. Typically found on the lower cheeks and jaws where the skin tends to be thicker.
• Boxcar
U-shaped scars with sharp edges. It can either be shallow or deep. It is usually found on the lower cheeks and jaws.
• Hypertrophic scars or keloids
These are raised scars due to an over-production of collagen during healing. Hypertrophic scars can be tender to the touch, painful, or itchy. They occur most commonly on the back and chest.
Your skin is made up of three layers: the epidermis, the dermis, and the hyperdermis. If someone has moderately severe to severe acne, they are more likely to have numerous inflamed pimples, nodules, and cysts which could penetrate the layers of the skin deeply. Basically, the deeper the penetration, the deeper and more obvious the scar. This is because our bodies will always try to heal our wounds; it does so using collagen. If too little or too much collagen is produced during the healing process, a scar is formed.
Depressed or atrophic scarring consists of three common acne scars which are3:
• Icepick
V-shaped and narrow like an ice pick. It goes deep into the skin and is the most difficult to treat. It is most commonly formed on the forehead and the upper cheeks where the skin tends to be thinner.
• Rolling
Rounded and irregular. It gives your skin a wavy and uneven appearance. Typically found on the lower cheeks and jaws where the skin tends to be thicker.
| Grade 1 | Macular: red and flat scar |
| Grade 2 | Mild: scar that is easily covered by makeup or hair |
| Grade 3 | Moderate: not easily covered by makeup or hair, visually obvious at less than 50 centimetres |
| Grade 4 | Severe: unlikely that makeup or hair can cover up, visually obvious at more than 50 centimetres |
The treatment for acne scarring is multi-fold and dependent on the grade of your scars.
Grade 1 and 2 scars:
• Alpha hydroxy acids: mild acid that removes old skin to reveal the new skin underneath.
• Retinoids: also known as retinol commercially, helps block inflammation, improves cell regeneration, and reduces acne lesions.
• Salicylic acids: helps reduce swelling and redness which may help improve appearance of acne scarring.
• Lactic acids: works as a peel that removes dead skin cells, which may help improve the appearance of acne scarring.
• Silicone dressings: helps reduce the appearance and size of acne scars.
Grade 3 and 4 scars:
• Chemical peels: helps reduce the size and appearance of acne scars.
• Injections: corticosteroid injections can help soften and flatten hypertrophic acne scars.
• Dermal filler: soft tissue fillers that are particularly helpful with rolling and boxcar scars.
• Micro-needling: encourages the production of collagen which can help smoothen the skin and improve the appearance of acne scars.
• Laser treatment: uppermost layer of skin is removed to reveal the new skin beneath. It helps reduce the texture and appearance of acne scars.
