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What to Know About Rolling Scars

Medically Reviewed by Dan Brennan, MD on June 13, 2021

Acne is a common skin condition among the larger population. As acne heals and clears up, it may leave marks on the skin resulting in rolling scars.

Skin scars are also part of the normal healing process after a burn or other trauma such as surgery or injury. 

Acne and Rolling Scars

Post-acne scarring can significantly affect your quality of life, especially as a young person. Appropriate intervention and assessment of the severity of scarring are necessary. Medical experts conduct a review by classification of the scars. They classify the scars into three different types: atrophic, hypertrophic, or keloidal. 

The keloid scar type is abnormal and can cause you a lot of emotional and physical stress if not treated. Hypertrophic scars have excessive collagen deposits, causing a raised spot but not as bad as the keloidal ones. Atrophic scars are indented and heal below the skin layer when the skin cannot create new tissue, leaving imbalanced scarring.

Atrophic scars may be sunken due to the loss of tissue, resembling ice pick pits. They may also appear to be rolling, creating a wavy texture in the skin. In other cases, they appear boxlike, hence the name boxcar acne scars.

Causes of Rolling Scars

Rolling scars happen because of bands of scar tissue that form under the skin. They give the surface of the skin a rolling and uneven appearance. They also develop because of dermal tethering to the subcutis tissue. They're typically 4 to 5 millimeters wide and give a rolling or undulating appearance to the skin. They appear like the letter “M”.

Treatment of Rolling Scars

Rolling scars can be a stress factor in your life, but it's possible to manage them effectively. In some cases, home remedies are effective in treating these scars. If home remedies fail, skin experts may recommend surgical treatment of acne. The success of these treatment procedures depends on the following factors:

  • Your age
  • Your overall health and medical history
  • The type of scar
  • Your reaction to different medicines and therapies

Treatment of post-acne scars remains a therapeutic challenge that requires a combination of many techniques for the various types of scars. The deeper the spot, the more challenging it is to find the right mix of techniques.

With proper treatment, you can minimize the scarring caused by acne.

Chemical peels. This is a quick outpatient procedure used to treat acne scarring. Rolling scars respond well to mild and medium depth peels such as alpha hydroxyl acids, salicylic acid, and Jessner’s solution.

Dermabrasion and microdermabrasion. These are facial resurfacing techniques that mechanically cut through damaged skin to promote skin recovery. Dermabrasion and microdermabrasion use different instruments with different execution techniques.

Micro-needling. This is a very simple, effective, and minimally invasive therapeutic technique initially introduced for skin rejuvenation. A micro-needling device with technological features such as needles, tips, or pins exfoliates the skin. It's a safe technique that skin experts can combine with other surgical procedures for better results. 

Dermal Grafting. Skin grafting is used to cover superficial defects temporarily or permanently. This involves transplanting skin from one part of the body to another to protect the host bed from further trauma. It also provides an important barrier to infection.

Subcision. This is a simple surgical procedure that involves the use of a special needle to release sub-dermal bands responsible for rolling scars.

Once the tethered scar is "released," it allows new collagen to form beneath the scar. This, in turn, helps to lift and smooth the surface contour. Deeper, wider, and more noticeable rolling scars improve more dramatically after subcision therapy.

Cryotherapy. With this treatment, the scarred tissues are frozen, causing them to die and subsequently fall off. One possible risk of the procedure is the lightening of the skin, which makes the treated area lighter than the rest of your body.

Other treatment options for rolling scars include:

  • Combined therapy
  • Laser resurfacing and light therapies
  • Autologous fat transfer
  • Topical creams

The ultimate goal of seeking treatment for your acne scars should be to improve the skin rather than the complete disappearance of the scars. Choosing the correct procedure for your skin is the first step towards achieving better skin.

WebMD Medical Reference

Sources

SOURCES:

Dermatological surgery: official publication for American Society for Dermatologic Surgery: “A review and update of Treatment Options Using the Acne Scar Classification System.”

Dermatology Research and Practice: "Acne Scars: Pathogenesis, Classification, and Treatment."

Indian Dermatology Online Journal: “Microneedling: Advances and widening horizons.”

The Journal of Clinical and Aesthetic Dermatology: “Acne Scarring- Pathogenesis, Evaluation, and Treatment Options,” “Keloids:  A review of Etiology, Prevention, and Treatment.”

Journal of Cutaneous and Aesthetic Surgery: “An Assessment of the Efficacy and Safety of CROSS Technique with 100% TCA in the Management of Ice Pick Acne Scars,” “Outcome of Dermal Grafting in the Management of Atrophic Facial Scars.”

Journal of Oral and Maxillofacial Pathology: “Keloid: A case report and review of pathophysiology and differences between keloid and hypertrophic scars.”

Sage Journals: “Lasers and ancillary treatments for scar management Part 2: Keloid, hypertrophic, pigment and acne scars.”

The Journal of Clinical and Aesthetic Dermatology: “A Combination Approach to Treating Acne Scars in All Skin Types: Carbolic Chemical Reconstruction of Skin Scars, Blunt Bi-level Cannula Subcision, and Microneedling-A Case Series.”

University of Rochester Medical Centre: “Acne Scar Removal.”

U.S. Food and Drug Administration: “Microneedling device.”

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