What Are Boxcar Scars?
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Boxcar Scars - Causes, Risk Factors, and Treatment

Published on Jan 24, 2023   -  4 min read


Boxcars are a kind of acne scar that causes rounded dents or craters in the skin. Read this article below to know more about it.

What Are Boxcar Scars?

Acne scars can be categorized into three types: atrophic, hypertrophic, or keloidal. Of all the three types, atrophic acne scars are the most common. Further, atrophic scars are divided into ice pick, rolling, and boxcar scars. Boxcar scars are atrophic scars that lead to craters or rounded dents in the skin, which often take longer to resolve than other acne scars and even may not entirely return to their previous condition after healing. These scars do not require urgent medical attention, but they can have a marked impact on someone's mental health due to their appearance. If that is the case, people may speak to a healthcare professional about their treatment options.

What Does a Boxcar Scar Look Like?

A boxcar scar appears as a round or oval depression or dents in the skin left behind after certain acne forms heal. Boxcar scars may look red or dark brown or skin colored.

What Causes Boxcar Scars?

It is still unclear why boxcar scars occur. For example, some people are prone to get atrophic scars from mild acne, whereas others may have raised or keloid scars. Yet others do not get scars at all. Instead, most boxcar scars are related to nodular or cystic acne (a type of acne in which complex and painful cysts are formed beneath the skin). It is believed that when atrophic acne heals, the skin has difficulty replacing lost collagen. Collagen is a protein that helps support the skin's texture and appearance, so a lack of collagen causes dents or depressions in the skin.

What Are the Risk Factors for Boxcar Scars?

Some risk factors make boxcar scars more likely, including

How Are Boxcar Scars Treated?

Boxcar scars may fade away, but they do not resolve entirely independently. However, medical treatment can improve the appearance of most people by 50 % to 75 %, making them less noticeable. Several ways can lessen the appearance of boxcar scars, including

  • Microdermabrasion: This is a minimally invasive non-surgical procedure in which the very top layer of the skin is removed using an abrasive instrument. It helps exfoliate dead cells and boosts the skin to produce more collagen. However, it is only effective for shallow scars and does not treat deep scars. In addition, it has few side effects.

  • Dermabrasion: This is a deeper form of microdermabrasion treatment that removes the whole top layer of skin with a handheld device. It may help enhance the appearance of scars, but it can also make skin red, sore, and sensitive to the sun for a few months. Dermabrasion can be done on the whole face or individual acne scars.

  • Chemical Peels: These treatments use different types of chemicals to strip the top layer of the skin to stimulate healthy skin growth. They can be superficial, medium, or profound, but most medical professionals recommend only superficial and medium chemical peels for acne scars. A deeper chemical peel can cause redness, pain, and skin flaking. Common chemical peels include trichloroacetic acid (TCA), glycolic acid, and Jessner's solution.

  • Microneedling: In micro-needling, the medical professional uses a device with thin needles to puncture the scarred skin. These needles may cause minor injuries. However, the skin heals the damage, produces more collagen, and reduces scarring. This treatment can cause a slight swelling, facial pain, and redness after the procedure.

  • Derma Fillers: They are injected into the skin to raise the severely indented scars. Derma fillers can be temporary, semi-permanent, or permanent. These injections can diminish pitting and even out the skin.

  • Punch Excision: This treatment works best for relatively tiny individual scars because they can easily fit the shape of the punch device. Punch excision can effectively remove the scars entirely. In punch excision, acne scars are removed using a punch device similar to those used for hair transplants.

  • Laser therapy: It is a long-lasting and effective treatment to improve acne scars. In this treatment, medical professionals use targeted intense pulses of light energy to stimulate the skin to heal and make collagen. Two common types of lasers used for acne scars are ablative and non-ablative.

    • Ablative Lasers: They are the most effective acne scar therapy. It can improve scars in one session. It damages the skin’s top layer and stimulates the scar's new collagen production and remodeling. However, it causes redness, pain, itching, swelling, and blisters.

    • Non-ablative Lasers: These types of lasers target areas below the top layer of skin. They also promote the production of new collagen. Non-ablative lasers may have fewer side effects but are less effective than ablative lasers. Nd: YAG is a kind of non-ablative laser that is commonly used on darker skin. It penetrates deeper into the skin without affecting its top layer. Each type of laser treatment makes skin sensitive to the sun.

How Are Boxcar Scars Prevented?

One of the easiest ways to prevent boxcar scars is to treat cystic or nodular acne before it scars in the first place. The more prolonged cystic acne is left untreated, the more it tends to scar after healing. Unlike other types of acne, cystic and nodular acne usually need prescription medications. Over-the-counter topical treatments do not treat the source of the problem because cystic or nodular acne forms deep under the skin. Instead, see a doctor.

They may suggest the following treatment options:

  • Vitamin A and its derivatives (retinoids) to unclog hair follicles.

  • Prescription cystic acne topical treatments to dry out the cysts.

  • Antibiotics to stop the overgrowth of acne-causing bacteria.

  • ‌ Avoid popping or picking any acne. Picking acne can turn it into an open wound rather than a closed bump. Open wounds often tend to scar, particularly if they are larger.


Boxcars are a kind of acne scars that cause rounded dents or craters in the skin. They are harmless, but they can be unsightly, significantly impacting someone's mental health due to their appearance. Boxcar scars may fade away, but they do not resolve completely on their own. However, medical treatments can improve the scar appearance by 50% to 75%, making them less noticeable. Speak to a medical professional for a prompt diagnosis and the most appropriate treatment.

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24 Jan 2023  -  4 min read




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