Why do boxcar scars form?
Boxcar acne scars form when long-term, inflammatory acne is healing and the body doesn’t make enough collagen during the healing process. The inflammation and lack of collagen during the acne lesion healing causes the scar to sink more deeply into the skin.
What are boxcar scars?
Boxcar acne scars are broad depressions with sharp edges. They are a type of atrophic scar and comprise 20-30% of atrophic acne scarring.
Boxcar Scars Treatment
Like other types of scars, boxcar scars are easier to treat the shallower they are. Deeper scars mean more layers of skin are affected and damaged, meaning more layers have to heal and come off for the scarring appearance to diminish, which is why deeper acne scars are harder to treat, and take more time to treat.
The location of the scarring, your skin type, and redness of the scarring also impact the treatment and the difficulty of the boxcar scar treatment.
- Microneedling: You can do microneedling in-office of a dermatologist, or using a dermaroller or dermapen device in your own home. Microneedling, similar to other invasive treatments, can’t be done everyday, as the skin needs time to heal and regenerate after each procedure. At-home microneedling can be done once every week to four weeks, and professional in-clinic microneedling usually needs 4 weeks in-between each session due to the deeper needles more intensive microneedling.
Microneedling is effective because it works to remove the top layer of skin while at the same time stimulating the skin’s collagen production and healing response to help remove damaged skin and reveal healthy new skin underneath.
Microneedling opens the skin up so it is more receptive to receiving topical ingredients that help with healing including Vitamin C and Copper peptides, which help with healing when applied after microneedling when done with a derma-roller at-home and in-clinic.
When doing at-home micro-needling, it is the easiest to do the micro-needling at night 1-2X a month, and then every night before bed put a light layer of the bright blue copper peptide cream on skin. Then in the morning you can use the clear Vitamin C serum to get a healthy glow while also aiding your skin in its protection and repair process.
- Microdermabrasion and dermabrasion: Microdermabrasion is done by a dermatologist in-office who uses a device to take off the top layer of your skin. Dermabrasion is similar but it is a deeper treatment that removes the entire top layer of skin and can cause redness and skin sensitivity afterward. These treatments can cause irritation and are not known as the best type of treatment in many cases. You should consult with your specific dermatologist to determine what the best treatment for your scarring and skin type is.
- Filler: Filler is injected into skin and can temporarily raise the skin under the scar to make it less noticeable. Filler can have adverse effects including swelling, infection, redness, pain, and it has to be redone every few months.
There are some semi-permanent and permanent filler types but they each have pros and cons, and permanent fillers can have to be removed due to complications.
- Punch excision: Punch excision is often used on boxcar scars and works to treat individual scars and stimulate healing, but does not heal redness caused by scarring.
- Subcision: a professional dermatologist can perform subcision on scars where a needle separates the top layer of skin from the scar tissue. Subcision is usually not as effective on boxcar scars but you can consult with your professional dermatologist to determine what is best for your specific situation.
- Chemical peels: Chemical peels use chemicals to take off the top layer of your skin which peels off and makes way for healthy new skin to grow underneath. These are only performed by a professional dermatologist in-office, and can have side effects of redness, pain, skin tone changes especially for those with naturally dark skin, and other complications.
- Lasers:Lasers work similarly to peels and other treatment types that remove the top layer of skin so healthy new skin has a chance to grow underneath. This is another procedure only performed by a professional dermatologist in-office, and like the other procedures needs multiple sessions to see results, as well as comes with its own set of side effects including sensitivity to the sun.