In 2001, an acne scar classification system was proposed by Jacob CI et al. According to the system, acne scars were classified as either: Icepick, Boxed or Rolling.
Icepick Scar
These are the most common type of acne scar. Icepick scars are very often narrow, sharp and deep. They give the appearance that the skin has been pierced with a sharp instrument or icepick. Often, they may appear as a deep, open pore. They usually extend into the deep dermis layer. Dermabrasion and laser resurfacing are often in-affective acne scar removal options for this type of scar since they are usually too deep into the skin surfaces. They usually develop from a cyst infection or after an inflamed blemish works its way to the skin’s surface. In the process skin tissue becomes destroyed, leaving these column-like scars.
Boxed Scar
Similar to chickenpox scars, boxed scars are rounded or oval depressions that usually occur on the temple and cheeks. They have sharp vertical edges and round to oval depressions. They are usually wider than ice picks and cause a pitted appearance in the skin. They do not taper to a point at the base like ice pick scars. Collagen beneath your top layers of skin can be destroyed during an acne breakout. The skin over that area is then left without support causing a depressed area.
Rolling Scar
These scars create a raised wave-like appearance on the skin surface and are normally wide and shallow. Rolling scars occur when fibrous bands of tissue develop between the outer layer of your skin and the tissue beneath it. This process gives the skin a rolling or undulating appearance. These types of scars must be corrected by breaking up the underlying fibrous bands.
Hypertrophic Scar
These scars appear as red, raised lumps which stay within the boundary of the original wound and can often shrink with the passage of time (months to years). Any kind of wound, in addition to acne, can cause these sorts of scars. They are sometimes confused with keloid scars but, unlike keloids, hypertropic scars tend to resolve on their own over time.
Keloid Scar
Are considered a more serious form of scar and can be defined as firm, rubbery lesions or shiny overgrowths of tissue which expand beyond the original wound site. The scar may itch and can vary in color from pink to red to dark brown. Keloid scars have many causes besides acne, inlcuding: surgery, accidents, and sometimes body piercings. In some cases they may even form spontaneously. Although they are benign and non-contagious they can be a cosmetic nuisance since they can continue growing. Keloid scars most commonly affect dark-skinned people but can occur on anyone.
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