Understanding Acne Rolling Scars: 7 Worst Causes and Treatment Options

Acne rolling scars are a type of atrophic scar that occurs as a result of long-term inflammatory acne. These scars have a rolling or wavy appearance and are characterized by broad depressions in the skin. Understanding the causes and treatment options for acne rolling scars can help individuals manage and reduce their roughy appearance. 

What are Acne Rolling Scars

Acne rolling scars, also known as rolling acne scars, are a form of atrophic acne scar that appears on the skin’s surface as minor depressions. During the healing process of acne lesions, injury to the collagen fibers beneath the skin causes these scars.

Woman with acne rolling scars

In contrast to other varieties of acne scars, such as ice pick scars and boxcar scars, rolling scars have a wave-like or rolling appearance. They possess rounded, descending edges and a depressed, undulating texture. These scars can cause the epidermis to appear wavy or unequal.

Typically, acne rolling scars form when fibrous bands of tissue form between the skin’s surface and deeper layers, drawing the skin downward and causing a depression. When the epidermis is stretched or tugged, these scars may become more obvious.

Types of Acne Rolling Scars

There are different types of acne rolling scars, each with its own characteristics. The three main types of acne rolling scars include:

1. Classic Rolling Scars

Classic Rolling Scars

These scars have a gentle, sloping, and wavy appearance. They are characterized by broad depressions in the skin that give a rolling or undulating appearance.

2. Boxcar Scars

Boxcar Scars

Boxcar scars are similar to rolling scars but have more defined edges. They appear as round or oval depressions with steep vertical sides. These scars can be shallow or deep, and their shape resembles the scars left by chickenpox.

3. Wave-Like Scars

Wave-like scars are a variant of rolling scars. They have a more pronounced and distinct wave-like pattern, with alternating peaks and valleys on the skin surface.

Causes of Acne Rolling Scars

The exact cause of acne rolling scars is not fully understood, but several factors contribute to their development. Here are some possible causes:

1. Inflammation: Prolonged inflammation associated with acne can lead to damage in the deeper layers of the skin, causing the formation of rolling scars.

2. Collagen Damage: Acne breakouts can disrupt the production and arrangement of collagen fibers, which are responsible for the skin’s strength and elasticity. This can result in the formation of depressed scars.

3. Tissue Loss: Severe or chronic acne can cause loss of subcutaneous fat tissue, leading to depressed areas and the appearance of rolling scars.

4. Fibrosis: In response to acne inflammation, the skin may produce excess fibrous tissue, leading to the formation of fibrotic bands. These bands can tether the skin, pulling it downward and creating the characteristic rolling appearance.

5. Genetics: Some individuals may be genetically predisposed to developing more severe forms of acne and subsequent scarring. Genetic factors can influence the body’s response to inflammation and wound healing, which can affect scar formation.

6. Delayed or Inadequate Treatment: Acne that is not properly treated or managed can increase the risk of scarring. Delayed treatment allows acne to persist, leading to more severe inflammation and tissue damage, which can result in rolling scars.

7. Picking or Squeezing Acne Lesions: Manipulating or picking at acne lesions can worsen inflammation and increase the chances of scarring. Picking can damage the surrounding tissues, disrupt collagen fibers, and lead to the formation of scars, including rolling scars.

Treatment Options for Acne Rolling Scars

1. Dermal Fillers: Injectable dermal fillers, such as hyaluronic acid, can be used to temporarily fill in the depressed areas of rolling scars. This treatment provides immediate improvement in the appearance of the scars, but the effects are temporary and require repeated treatments.

2. Subcision: This procedure involves using a needle to break up the fibrous bands that are pulling the skin downward, causing the rolling appearance. Subcision helps release the scars, allowing them to rise to the surface and become less noticeable.

3. Microneedling: Also known as collagen induction therapy, microneedling involves using a device with tiny needles to create controlled micro-injuries in the skin. This stimulates collagen production and can improve the appearance of rolling scars over time.

4. Laser Therapy: Various laser treatments, such as fractional laser resurfacing or ablative lasers, can help stimulate collagen production and improve the appearance of rolling scars. Laser therapy can also target the underlying pigmentation associated with acne scars.

5. Chemical Peels: Chemical peels involve applying a chemical solution to the skin, which exfoliates the top layers and promotes new skin cell growth. Superficial peels can help improve the texture and appearance of rolling scars.

6. Surgical Excision: For deep rolling scars, surgical excision may be an option. This involves removing the scar tissue and closing the wound with sutures. Surgical excision is usually reserved for severe cases.

Consulting with a dermatologist or skincare professional is important to accurately diagnose and determine the most appropriate treatment options for your specific type of acne rolling scars.