Preventing and Treating Boxcar Acne Scars — 6 Treatment Options To Choose From

Boxcar acne scars are a form of atrophic acne scar with a box-like or rectangular shape and clearly defined margins. 

They typically manifest as skin depressions resembling a tiny indentation or crevice. Damage to the collagen fibers in the deeper layers of epidermis causes boxcar scarring.

Boxcar acne scars are the result of collagen injury caused by acne inflammation. Collagen is responsible for providing support and structure to the epidermis. Inflammation can disrupt the normal healing process and lead to scar tissue formation.

What causes boxcar acne scars?

Inflammatory Acne

Inflammatory acne, which includes papules, pustules, and cysts, causes more severe inflammation than non-inflammatory acne, which includes blackheads and whiteheads. The increased inflammation can contribute to the formation of boxcar scars by causing injury to the collagen fibers.

Acne outbreaks cause an immune response, resulting in the production of matrix metalloproteinases (MMPs) enzymes. These enzymes aid in the breakdown of damaged collagen fibers, but they may also cause the loss of healthy collagen. The loss of collagen weakens the skin’s support structure, resulting in boxcar scars, which are depressions or indentations on the skin’s surface.

Persistent acne

Individuals with severe or persistent acne, those who delay or receive inadequate treatment for acne, and those with a genetic predisposition to scar formation are more likely to develop boxcar scars. In addition, plucking or compressing acne lesions can exacerbate inflammation and increase the likelihood of boxcar scarring.

It is essential to promptly address acne outbreaks and seek appropriate treatment to reduce the risk of developing boxcar scarring. Early intervention and effective acne management can aid in reducing inflammation, promoting proper healing, and possibly preventing or minimizing the formation of these scars.

Good hygiene practices, early intervention, and professional treatments are required for the prevention and treatment of boxcar acne scarring. Here are some tips:

How to prevent boxcar acne scars?

  1. Treat acne as soon as possible. Early and effective treatment of acne can reduce the likelihood of boxcar scarring. Consult a dermatologist for acne treatment recommendations.
  1.  Refrain from picking or breaking zits. Picking at acne lesions can result in increased inflammation and scarring. Resist the urge to compress or burst zits.
  1. Protect your skin from the sun, as UV radiation can make acne scars more visible. Always apply a broad-spectrum sunscreen with an SPF of 30 or higher and limit solar exposure, particularly during peak hours.

Treatment for boxcar acne scars



Over-the-counter or prescription creams containing retinoids, such as tretinoin, can promote skin cell turnover, reduce inflammation, and enhance the appearance of acne scarring over time.

Chemical Peels

Chemical peels entail the administration of a chemical solution to the skin, which exfoliates and stimulates collagen production. This can assist in diminishing the extent and appearance of boxcar wounds.


As stated previously, microneedling can also be beneficial for boxcar wounds. It induces controlled micro-injuries in the epidermis, which stimulates collagen production and enhances the texture and appearance of scars.

Injectable filler

Injectable filler

Injectable fillers, such as hyaluronic acid, can be used to elevate and fill in boxcar scars, thereby reducing their visibility. The effects are transitory and may require periodic maintenance.

Laser treatments

Fractional laser resurfacing can assist in remodeling scar tissue and stimulating collagen production, resulting in a smoother skin texture. Depending on the severity of the scarring, various lasers, including CO2 lasers and erbium lasers, may be utilized.

Key Takeaways

Boxcar acne scars must be treated by a dermatologist or skin care professional who can evaluate your unique condition and recommend the most effective treatment options. Optimal results may necessitate the use of multiple treatment sessions and a combination of methods.