A Review and Update of Treatment Options Using the Acne Scar Classification System

Dermatol Surg. 2019 Mar;45(3):411-422. doi: 10.1097/DSS.0000000000001765.


Background: An unfortunate consequence of acne vulgaris is residual scarring that can negatively affect a patient's quality of life.

Objective: Jacob and colleagues have previously described an acne scar classification system based on acne scar pathology that divided atrophic acne scars into icepick, rolling, and boxcar scars, and this review will evaluate new and developing treatment options for acne scarring.

Methods: A Medline search was performed on the various treatments for acne scars, and particular attention was placed on articles that used the acne scar classification system of icepick, rolling, and boxcar scars.

Results: Therapies for acne scarring included surgical modalities, such as subcision, and punch excision and elevation, injectable fillers, chemical peels, dermabrasion, microneedling, and energy-based devices. In the past decade, there has been a trend toward using cosmetic fillers and energy-based devices to improve acne scarring.

Conclusion: There were few high-quality evidence-based studies evaluating the management of acne scarring. Many disparate acne severity scores were used in these studies, and the acne scar type was frequently undefined, making comparison between them difficult. Nonetheless, research into interventions for acne scarring has increased substantially in the past decade and has given patients more therapeutic strategies.

Publication types

  • Review

MeSH terms

  • Acne Vulgaris / complications*
  • Chemexfoliation
  • Cicatrix / classification*
  • Cicatrix / etiology
  • Cicatrix / pathology
  • Cicatrix / therapy*
  • Cosmetic Techniques
  • Dermabrasion
  • Dermal Fillers / therapeutic use
  • Dermatologic Surgical Procedures
  • Humans
  • Needles
  • Quality of Life
  • Radiofrequency Therapy


  • Dermal Fillers