What are ice pick scars?

Ice pick scars are a type of acne scar. Due to their depth and narrow impressions, ice pick scars are more severe than boxcar, atrophic, or other types of acne scars.

Their severity also makes them difficult to treat at home. You may even be looking at professional options right now because at-home remedies and drugstore products have failed.

Although professional treatments may not completely get rid of the scar, you should notice marked improvements in appearance and texture.

Keep reading to learn how to differentiate ice pick scars from other acne scars, why they form in the first place, and what your dermatologist can do to help.

What do ice pick scars look like and why do they form?

Like other types of acne scars, ice pick scars are remnants of a severe acne lesion or outbreak.

Some acne scars are atrophic, meaning they are thin and flat. Both rolling and boxcar scars are wide, but have either sloping or sharp edges.

Ice pick scars are narrower than atrophic acne scars, but are also deeper than all types of scars. They’re characterized by narrow pitted shapes in the skin. These shapes are often more noticeable to the naked eye.

Ice pick scars are usually caused by severe acne, such as cysts and papules that occur deep in your pores.

What treatment options are available?

Traditional treatment consists of surgery or resurfacing procedures performed by a dermatologist. Instead of relying on one single method, you may see the most improvement after both surgery and resurfacing.

Your dermatologist can help you weigh the pros and cons of each of the following options.

Punch grafting

According to an article published in The Journal of Clinical and Aesthetic Dermatology, punch grafting is the best treatment for ice pick scars. This treatment involves taking out the scar and replacing it with a skin graft (usually from behind your ear).

Punch grafting is guaranteed to fill in deep, narrow ice pick scars. The downside is that you will need multiple grafts — sometimes up to 20 — for a single scar. Sometimes, the resulting area is slightly more elevated than the surrounding area of skin.

Punch excision

A punch excision is a method that involves cutting out the ice pick scar. After the excision process, your skin is closed up from all sides.

Punch excision is one of the most effective treatments for ice pick scars. However, you’ll still be left with a thin scar in its place.

Although punch excision helps treat texture problems, it doesn’t get rid of any surrounding skin discoloration. You may need to complement this one-time surgical method with a resurfacing treatment.

Laser resurfacing

Laser resurfacing is traditionally seen as an anti-aging procedure used to fill fine lines and wrinkles. But it can also help with acne scars.

During the procedure, your dermatologist will use high-frequency laser lights to target the ice pick scar. Both ablative and nonablative lasers are available.

Nonablative lasers promote collagen production, which may be more suitable if you’re looking to improve both skin tone and wrinkles. Ablative laser treatments, on the other hand, work to remove skin layers only. Ablative lasers also carry the risk of further scarring.

Laser resurfacing can also cause:

  • redness that can last for weeks
  • acne
  • blisters
  • swelling
  • severe itching
  • changes in your skin color
  • sensitivity to the sun (post-treatment sunscreen is a must)

Despite the risk for side effects, laser resurfacing may be preferable if you want long-lasting results without having to go back to the dermatologist every few weeks.

According to Mayo Clinic, you may start seeing results almost immediately, and these can last for several years.

Microneedling

With microneedling, multiple fine needles puncture the top layer of your skin. This creates multiple microscopic holes in your skin to encourage peeling of the epidermis and mid-dermis and help trigger the production of collagen and elastin.

Results can be seen within 6 to 12 weeks after treatment.

This treatment is popular because it’s relatively affordable compared to other outpatient procedures. There’s also less risk of side effects, although slight bruising can occur during the process.

Microdermabrasion

Microdermabrasion is a type of skin resurfacing treatment. Your dermatologist will use small crystals blown onto the skin or a diamond-tipped handpiece that they rub across the skin to remove the upper portion of your skin. This reveals the smoother, toned skin underneath.

There are little to no side effects with this treatment. However, the effects may be more subtle than those of more powerful treatments, such as dermabrasion and chemical peels.

You may wish to use microdermabrasion to complement surgical acne scar treatments, such as punch excisions, by making leftover scarring less noticeable. As well, microdermabrasion kits can also be purchased for at-home use.

Dermabrasion

Microdermabrasion is an offspring of a common dermatologic procedure called dermabrasion.

With dermabrasion, your dermatologist will use a power tool with an abrasive end piece, such as a wire brush or metal wheel that’s serrated, instead of ablative crystals.

During the procedure, the tool is moved quickly along your skin, removing the epidermis. At the same time, the upper layer of the ice pick scar is removed. The ideal result is a smoother and less pitted appearance.

Although it may be more effective for ice pick scars than microdermabrasion, dermabrasion is still a skin resurfacing technique with only temporary results. This means you would need to go back to your dermatologist for multiple treatments.

As the area heals, you may have a pink skin tone for up to three months.

If you have eczema, dermabrasion could aggravate your skin further. Acne flare-ups and enlarged pores are also possible. There’s a slight risk of infection, which should be treated promptly with antibiotics.

Chemical peels

Chemical peels can help reduce the appearance of ice pick scars by removing the upper layer of your skin.

Standard chemical peels — done professionally and through at-home kits — often contain glycolic acid (“medium” peels). Other kinds may have Jessner’s solution or trichloroacetic acid (TCA).

Chemical peels involving alpha hydroxy (“lunchtime peels”) are quicker, but these only have superficial effects.

Deep peels have the most dramatic benefits, but the powerful effects can make your skin red and irritated.

Another treatment option is the TCA CROSS procedure. TCA (50 – 100 percent) is applied to the scar with a wooden toothpick. This induces inflammation followed by the generation of collagen, leading to reduction in the appearance of scars and cosmetic improvement. It has been found to be a safe, cost-effective, and minimally invasive technique.

All chemical peels increase sun sensitivity, but deep peels especially increase your risk for sunburn. In fact, the American Society for Dermatologic Surgery recommends that you avoid the sun for three to six months entirely after having a deep peel.

You also shouldn’t use a chemical peel if you have sensitive skin or have recently taken acne medications.

Will over-the-counter (OTC) creams and other topicals work?

OTC topical remedies aren’t powerful enough to treat these types of acne scars. Bleaching agents, such as hydroquinone, can reduce redness and brown spots, but these types of products can’t fix the deep, narrow pit of an ice pick scar.

Instead, it may be helpful to use certain OTCs as part of a good skin care regimen. Healthy skin not only helps to distract from scars, but it can also reduce the risk for future acne outbreaks and further scarring.

Be sure to wear sunscreen every day. This will help protect your skin from age spots and cancer, and it will also prevent from ice pick scars from darkening.

Will natural remedies work?

Like OTC products, natural remedies aren’t strong enough to treat ice pick scars alone.

Certain products — such as honey, rosehip oil, and witch hazel — may decrease discoloration and improve overall skin texture, but they won’t be able to get rid of the leftover deep pits that make up these types of scars.

The bottom line

Most severe acne scars never completely go away, despite treatment. But ice pick scars can decrease in appearance with time and patience. Work with your dermatologist to determine the best approach for your ice pick scars.

It’s important to keep in mind that insurance doesn’t cover treatments for ice pick scars. Your out-of-pocket cost depends on the type of treatment, as well as how often you’ll need follow-up procedures (if at all). It’s important to work out these details ahead of time so you aren’t caught by surprise.