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Even with the most thorough skin care routine, you can still find yourself victim to acne scars. But scars have different types and appearances. Most often they are categorized into two kinds: atrophic, meaning they are caused by a loss of tissue, and hypertrophic, meaning they are caused by excess tissue. These two categories encompass four distinct types: ice pick, boxcar, rolling, and keloid scars.

Dark marks due to acne are not really scars, they are a type of pigmentation that will diminish with time.

Types of Acne Scars

Ice Pick Scars

*Appearance: Ice pick scars are thin and profound. The name relates to the skin's appearance as though it's been stabbed by a sharp picked edge. The scars develop into a deep narrow hole, with the look of a large, open pore.

*Development: Ice pick scars develop due to infections within cysts or other deeply inflamed blemishes. In the case of ice pick scars, skin tissue is lost leaving the deep hole.

*Common treatments: The treatment for ice pick scars is punch excision or punch grafting.

Boxcar Scars

*Appearance: Boxcar scars are rounded impressions that have deep vertical sides. They are bigger and not as narrow as ice pick scars, therefore giving the skin a pitted appearance.

*Development: Boxcar scars are created when an inflammatory breakout destroys collagen and tissue is lost. The lack of collagen means that the skin no longer has support and therefore a depression is developed. Boxcar scars can be small to severe, depending of the loss of tissue.

*Common treatments: Punch excision or elevation are the most common treatments for boxcar scars, as well as dermal fillers or laser resurfacing.

Rolling Scars

*Appearance: Rolling scars cause rolling or 'wave like' indentations across the skin.

*Development: These scars are created when fibrous bands of tissue is produced between the skin and subcutaneous tissue below. These tissues bind the skin to more profound structures. This reaction is what develops the rolling appearance of these types of scars.

*Common treatments: Rolling scars are most often treated with subcision.

Hypertrophic or Keloid Scars

*Appearance: A hypertrophic scar is a hard mass of tissue. These types of scars usually develop to a larger size than the original wound. This type of scar is most often found in men in the area of the torse.

*Development: These scars are unique in that they are caused by an excess of collagen and therefore tissue.

*Common treatments: These scars are most effectively treated with steroid (cortisone) creams, tapes, or injections that flatten or reduce the area of raised scar tissue. Interferon injections soften scar tissue and are also a frequent treatment when dealing with hypertrophic scars.