Acne Scars - Types and Accutane Considerations

In July 2001 Jacob et al proposed an acne scarring classification system that also assists in determining effective scar treatment procedures. According to this system acne scars are classified as icepick, rolling, and boxcar based on the appearance of the scar. After taking into account previous accutane use, facial scars are mapped out and a staged treatment plan is developed.

Acne Scars - Icepick
Icepick scars are narrow, sharp scars that make the skin appear it has been punctured with an icepick. They are usually narrower than 2 mm and extend into the deep dermis or subcutaneous layer. Icepick scars are usually too deep to correct with skin resurfacing treatments such as dermabrasion or laser resurfacing.

Acne Scars - Boxcar
Boxcar scars are round to oval depressions that have sharp vertical edges. Unlike icepick scars they do not taper to a point at the base. Shallow boxcar scars are 0.1-0.5 mm in depth and can usually be treated with conventional skin resurfacing techniques. Deep boxcar scars are >0.5 mm in depth and require full-thickness treatment techniques.

Acne Scars - Rolling
Rolling scars occur as a result of tethering of otherwise normal-appearing skin to the subcutaneous tissue below. This process gives the skin a rolling or undulating appearance. Conventional skin resurfacing techniques do not work on rolling scars. They must be corrected by breaking up the subcutaneous fibrous bands.

Acne Scar Treatment After Accutane
An important consideration in the treatment of acne scars is the past use of accutane. Accutane is a powerful medication that can significantly remodel skin. However, studies have shown that people who have resurfacing procedures performed within 6 months of finishing accutane therapy have a higher risk of developing scarring as a result of the procedure. Based on this data, most physicians do not surgically treat patients who have taken accutane in the past 12 months.

Acne Scar Treatment Stages
Treating acne scars usually takes several procedures performed in stages. Often several surgical procedures are used in different areas to correct large defects. Then a resurfacing procedure is used to smooth out any scars created from the first stage, and to correct shallow defects. Just using a resurfacing procedure does not correct deep scars. Properly treating acne scars involves a significant investment of time and money, but the results can be dramatic.