The 5 Types Of Acne Scars Explained + What To Do About Them

mbg Beauty and Lifestyle Senior Editor By Alexandra Engler
mbg Beauty and Lifestyle Senior Editor
Alexandra Engler is the Beauty and Lifestyle Senior Editor. She received her journalism degree from Marquette University, graduating first in the department. She has worked at many top publications and brands including Harper's Bazaar, Marie Claire, SELF, and Cosmopolitan; her byline has appeared in Esquire, Sports Illustrated, and Allure.com.
Medical review by Keira Barr, M.D.
Board-certified dermatologist
Keira Barr is a dual board-certified dermatologist and founder of the Resilient Health Institute.

Image by Leandro Crespi / Stocksy

Acne is hard enough in the moment—not only is it tricky to heal, but we know it can affect our mental health, too. Even if you're one of the lucky ones to grow out of it (adult acne is very much real!), there's a chance you might develop scarring. And scarring, unfortunately, can be lifelong. 

The most basic, general explanation of why acne scars form is they are the result of inflamed blemishes on the skin, according to the American Society of Dermatological Surgery. When pores clog and swell from trapped sebum, dirt, and bacteria, it can rupture the pore's walls—both near the surface and in the dermis. The skin then goes into repair mode by producing new collagen fibers, but unfortunately, these are often not as smooth and uniform as the original skin. It's estimated that 95% of the patients with acne vulgaris develop scarring of some kind. How the resulting scar tissue looks can actually vary quite a bit, and patients can have multiple types on the skin—and even within the same area. There's also no indication of what type of scarring a person might develop. "Different people heal differently and are prone to different types of scarring. Some will be more prone to the ice-pick versus rolling scars," says board-certified dermatologist Jeremy Fenton, M.D., at Schweiger Dermatology Group in New York City. "One person may get no scarring, while another gets severe scars from a similar severity of acne."  

But before we get into the various types of acne scars, the first rule is don't pick at existing acne. Picking at pimples only further damages the surrounding tissue, can prolong a lesion, and can encourage more breakouts, starting the cycle all over again. Another tip for preventing scarring: Since scars are the result of damaging inflammation, anyone suffering from acne could benefit from a topical anti-inflammatory, according to research. As for the treatment itself, like any scar tissue, acne scars are complicated to treat. Research shows that the most effective protocols involve multiple, complementary modalities.

And while we like to provide you with simple, natural skin care options here at mbg, I also don't want to be misleading: This is scar tissue after all, and scar tissue is incredibly challenging to treat at home or topically. As forewarning, to fully get rid of scarring, it might mean more extreme measures.

If that's not an option, or you're not interested in that, just remember acne scars are incredibly common and you're likely your harshest critic. Just stick to a regular skin care plan that works for you—as healthy skin will just improve the appearance of skin quality overall.

 1. Ice pick scars

Ice pick scars are a form of atrophic scar, which means it's indented rather than raised. (Research shows that 80 to 90% of people with acne scars have indented.) Unfortunately, of the atrophic scars, ice picks are the hardest. These look like small, narrow pinholes in the skin, with steep fall-offs. ("They are named 'ice pick' scars because they look like an ice pick was used on the skin," says Fenton.) They're also very deep, often diving into the lower levels of the dermis, and are most often formed by cystic acne.

How can you treat ice pick scars? 

As noted above, these are incredibly hard to treat. In some cases, you can never fully "fix" the scars, due to the depth of the injury. These will need a trip to the dermatologist's office for a professional consultation, with suggested treatments that range from filler, fractional lasers, and chemical peels to punch excision. Because of the depth of the scars, topical and natural remedies can't rid the skin of them.

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2. Boxcar scars

Another form of atrophic scarring, boxcars look like small oval, circular, rectangular, or square pits. They often have steep drop-offs into a "U" shaped scar. These are unlike ice pick scars in that they are wider and don't usually go deep into the dermis. Because they are more shallow, they also are easier to treat.  

How can you treat boxcar scars? 

Boxcar scars respond to fractional laser therapy, research shows. (It can be painful and requires downtime, however.) They also respond to chemical peels—like glycolic, which is generally tolerable for most patients—if done regularly. Additional treatments include subcision, microneedling, and platelet-rich plasma. As for at-home treatments, consider natural acids of your own: Glycolic treatments can help exfoliate the top layer of skin. Also consider a retinol, or retinol alternative, which will speed up cell turnover. 

3. Rolling scars

Rolling scars are another form of atrophic scarring. They are characterized by wavelike, undulating skin. These are the result of long-term, chronic acne—as the repeated inflammation and trauma to the skin creates uneven scar tissue. In many cases the appearance is shallow and perhaps not very noticeable. With time, however, rolling acne tends to exacerbate as the skin naturally starts to sag.  

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How can you treat rolling scars? 

As far as treatments go, you can consider rolling and boxcar sister scars—so what was mentioned above can be applied here (the natural, at-home acids and retinol included!). And, notes Fenton, rolling tend to be the most receptive to treatment in general: "These have a better response to various treatments compared to other scars." Studies have also shown that rolling scars do respond well to microneedling, a treatment in which the patient or doctor rolls a device on the face creating tiny injuries to spur collagen production. You'll likely have to do a few sessions, and results take about six weeks to three months, with full results taking about a year. 

4. Keloids

Now, on the other hand, keloids are hypertrophic scars, which means that instead of a depletion in the skin, there's an excess of scar tissue. These form as the result of acne—or just general injuries. These are more common on those with darker skin tones and appear more frequently from body acne. 

How can you treat keloids?

Keloids take dermatologic intervention, and there's not much you can do on your own. Also: If you develop them once, it likely means you are at risk at developing them again

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5. Hypo- or hyperpigmentation

These aren't technically a scar in the same way the above are, but they usually fall under this umbrella when discussing acne. According to the most widely accepted standard grading scale of acne, pigmentation issues are considered "macular," or the most mild form. These are surface-level stains where the pigment of the skin is altered due to inflammation—essentially when skin is inflamed, it can trigger or halt pigment production. Hyperpigmentation on pale skin tones often appear red or pink, while darker skin tones usually appear brown or black. "The pigment then sits there until the body clears it out or it is exfoliated off," says Fenton. Hypo-pigmentation appears lighter than the rest of the skin.

 How can you treat these marks?

In some circumstances these marks are permanent, but most will fade within six months to two years. You can usually speed up the fading process with the right topical ingredients. Look for things labeled "brightening" or "spot corrector," has potent antioxidants like vitamin C, or consider topical retinoids or bakuchiol

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