Boxcar Scars: Home Treatments, Causes, and Outlook

What are boxcar acne scars?

Boxcar scars are a type of acne scar. Specifically, they are a type of atrophic scar, which is the most common type of acne scar. Boxcar scars make up about 20 to 30 percent of atrophic scars. The other types of atrophic scars are ice pick scars and rolling scars.

Boxcar scars look like a round or oval depression or crater in your skin. They typically have sharp vertical edges, and are wider than ice pick scars but not as wide as rolling scars. Shallow ones may respond well to treatment, but deeper scars may be harder to get rid of.

Read on to learn more about boxcar scars and how to treat them.

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A type of scar that can commonly occur from an acne lesion is a boxcar acne scar. Photo courtesy of Rumansava [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
Boxcar scars treatment

Treatment for boxcar scars depends on several factors, such as how red the scars are, how deep they are, the location of the scarring, and your skin type.

Shallow scars may be easier to treat than deep scars. In many cases, combining treatments is best for reducing the appearance of boxcar scars.

Microdermabrasion

Microdermabrasion is a superficial procedure that removes the very top layer of your skin. A dermatologist will rub small crystals across your skin. It doesn't treat deep scars, but has very few side effects.

This type of treatment is also commonly performed at medical spas and not by a dermatologist. Results may vary.

Dermabrasion

Dermabrasion is similar to microdermabrasion but goes deeper to remove the whole top layer of skin using a machine-driven or handheld device. It can be done on your whole face or on individual scars.

Dermabrasion can help improve shallow boxcar scars, but is not as effective on deeper ones. It can make your skin red and sore for a few days, and sensitive to the sun for several months.

Fillers

Fillers are injected under the skin and used to fill in under the scar and raise the depression. Side effects can include redness, lumps, swelling, and pain.

Types of fillers include:

  • Temporary. These last a few months. They also increase collagen production, which helps improve scar appearance long term.
  • Semi-permanent. These last for up to two years.
  • Permanent. There's insufficient evidence of permanent fillers' effectiveness for reducing acne scars. However, they're being studied in clinical trials.

Chemical peels

Chemical peels use different types of chemicals to destroy the top layer of your skin. The skin then peels off, so that new, undamaged skin can grow.

Chemical peels should be performed by a board-licensed doctor, such as a dermatologist. The deeper the peel, the more likely you are to have side effects like redness, pain, and skin flaking.

Chemical peels can also cause skin to become darker or lighter than normal. These changes are more common in people who have darker skin.

Common types of peels include glycolic acid, trichloroacetic acid (TCA), and Jessner's solution. They can be superficial or 'medium,' depending on the concentration, number of coats, and if they're combined.

There's also a type of deep peel called a phenol peel. However, this is rarely used for acne scars.

Laser therapy

Laser therapy uses intense energy pulses to target acne scars. This is a long-lasting and usually effective treatment. There are two types of lasers used for acne scars: ablative and nonablative.

Ablative lasers are considered a top treatment for acne scars. They can often improve scars in just one session.

Ablative lasers damage the top layers of skin, and can cause redness, pain, swelling, itching, and blisters. They also stimulate the production of new collagen and remodeling of the scar.

Nonablative lasers also stimulate the production of new collagen, but they have fewer side effects than ablative lasers. However, they tend to be less effective.

Nd:YAG is a type of nonablative laser that's often used on darker skin. It goes deeper into the skin without affecting the top layer.

All types of laser treatment make your skin sensitive to the sun.

Microneedling

Microneedling uses a device with lots of very thin needles to puncture your skin. These needles cause small injuries. As your body heals the injuries, it builds more collagen and reduces scarring. Microneedling causes slight facial pain, swelling, and redness after the procedure.

Punch excision

During a punch excision, individual scars are removed with a punch device, similar to what's used for hair transplants. The deeper scars are replaced with small, shallower wound closures.

Punch excision is best for small scars that can easily fit the shape of the punch device. It only treats the individual scars, not any redness or unevenness caused by the scars.

Subcision

In subcision, a needle is put under your skin and moved in multiple directions to separate the top layer of skin from the scar tissue below.

The resulting healing process causes collagen to form and push the scar up.

This is not as effective a treatment for boxcar scars as the above treatments are. However, it only has minor, short-term side effects, such as bruising and pain during the procedure.

Can boxcar scars go away on their own?

Boxcar scars may fade, but won't completely go away on their own. However, treatment can improve the appearance of boxcar scars in most people by 50 to 75 percent. After treatment, they may not be noticeable anymore.

How do boxcar scars form?

Deep acne breakouts can damage the skin. Your body then tries to heal this damage by forming collagen. Boxcar scars form when your body doesn't produce enough collagen during this process. In this case, your skin doesn't have enough support and a boxcar scar will form as your skin heals.

Inflammatory acne, especially nodular-cystic acne, is more likely than other types of acne to scar, especially if left untreated. Picking at or popping pimples can also make scarring more likely. Genetics may also play a role in whether or not you develop scars from acne.

Other types of acne scars

Boxcar scars are a type of atrophic scar, which is one of three main types of acne scars. Other atrophic scars include:

  • ice pick scars, which are small, deep, and narrow
  • rolling scars, which are wide scars that make your skin look bumpy or uneven

The other main type of acne scar is hypertrophic, or keloid, scars. These are raised scars that form when your body produces too much collagen trying to heal the damage caused by acne. This type of acne scar is more common in people with darker skin.

Takeaway

Even with treatment, most deep boxcar scars will never totally go away. However, treatment is effective for shallow scars, and for improving the appearance of deeper scars. Talk to a dermatologist about the best treatment options for your scars.

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