Acne Scar 411: What You Should Know About Ice Pick Scars
The most common types of acne scars are atrophic, ice pick and hypertrophic scars. Atrophic scars are shallow pitted scars with smooth borders. Ice pick scars are a specific type of atrophic scars; ice pick scars are deep, pitted scars with very sharp borders.
All Acne Scars are Not Created Equal
There are different types of acne scars, and it is important to differentiate the types of scarring, as there are different approaches to treatment of each type of scarring. There are two main categories of acne scarring, atrophic (meaning loss of skin tissue) and hypertrophic (meaning excessive skin tissue.) Atrophic scars include ice pick scars, boxcar scars and rolling scars; keloid scars are an example of hypertrophic scars. Atrophic acne scars are by far the most common type of acne scar.
- Ice pick scars: Ice pick scars are very deep and narrow scars with a sharp border. They extend into the dermis and appear as though the skin was pierced with a sharp instrument, such as an ice pick. They may look like an enlarged pore.
- Boxcar scars: Boxcar scars are round sunken patches with a steep border. They appear “pitted,” though they are wider than ice pick scars.
- Rolling scars: Rolling scars appear as sunken “wavy” areas of the skin, without sharp borders.
- Hypertrophic scars: More commonly known as “keloid scars,” these appear as firm, raised masses on the skin. Hypertrophic scars are most commonly found of the back and chest, while atrophic scars are much more common on the face.
The Best Ways to Treat Ice Pick Scars
The gold standard method at treating ice pick scars is with the Fractional CO2 laser, which uses microscopic columns of laser energy to target a fraction of skin at a time. This method leads to collagen regeneration and a natural looking filling of the scar tissue. Chemical peels, such as the TCA Peel, can also be effective in the treatment of localized acne scars, particularly ice pick acne scars. TCA Peels for the treatment of acne scarring are often applied using the Chemical Reconstruction of Skin Scars method (more commonly known by its acronym, the CROSS method.) The CROSS method of TCA peeling utilizes very high concentrations of TCA, which are applied directly into the atrophic (pitted) scar, to stimulate collagen production on the scarred area. While peels can be used superficially, we feel that lasers give more consistent results, so we prefer laser surgery for the majority of our patients. A split-face study was conducted in 2009 with the use of the Fraxel laser on one side of the face and the CROSS method performed on the other side of the face. While icepick scars responded similarly to each method, rolling scars (the much more commonly seen acne scars referred to as “pitted” acne scars) responded significantly better to the Fraxel laser treatment than the CROSS method.
