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
