Boxcar scars are a common type of depressed scar that develops after skin inflammation. These indentations form when the normal healing process is disrupted. They can be a significant concern due to their impact on skin texture. Understanding their nature, formation, how they differ from other scar types, and available treatment options can help individuals improve their skin’s appearance.
Characteristics of Boxcar Scars
Boxcar scars are recognizable by their distinct visual features, appearing as round or oval indentations in the skin. They have sharp, well-defined vertical edges that descend into a relatively flat base, giving them a “box-like” or “crater-like” appearance. These scars vary in depth and size, often measuring a few millimeters wide. They are commonly found on thicker facial skin, such as the lower cheeks and jawline, and can resemble the pitted marks left by chickenpox.
The Formation of Boxcar Scars
Boxcar scars primarily develop from inflammatory skin conditions, most commonly severe acne (cystic or nodular). Other causes include chickenpox or injuries that damage the skin. During the healing process, the body attempts to repair damaged tissue. However, insufficient collagen production prevents the skin from fully regenerating to its smooth state. This lack of collagen leads to a depressed area, forming the characteristic indentation. Deeper inflammation increases the likelihood of significant tissue damage and subsequent scarring.
Boxcar Scars Versus Other Scar Types
Boxcar scars are a type of atrophic scar, meaning they are depressed due to tissue loss. This category also includes ice pick and rolling scars, each with unique characteristics. Boxcar scars have sharp, defined edges and a flat base, and are typically wider than ice pick scars. Ice pick scars are narrower, deeper, and V-shaped, appearing like tiny holes. Rolling scars are broad, shallow depressions with sloping, ill-defined edges, creating a wavy appearance. These differing appearances stem from variations in collagen loss and how underlying fibrous bands affect the skin.
Treatment Options for Boxcar Scars
Addressing boxcar scars often involves a multi-faceted approach, as a single treatment may not fully resolve their appearance. Treatment selection depends on factors such as scar depth, skin type, and individual goals. Consulting a dermatologist is important to determine the most suitable plan.
Energy-based treatments
Energy-based treatments are frequently used to stimulate collagen production and remodel skin. Fractional laser resurfacing, including ablative and non-ablative types, creates microscopic injuries to encourage new collagen growth and improve skin texture. Microneedling, sometimes combined with radiofrequency or platelet-rich plasma (PRP), also creates controlled micro-wounds to induce collagen and elastin production.
Surgical methods
Surgical methods can be effective for specific scar types. Subcision involves inserting a needle under the skin to break fibrous bands that pull the scar downward, allowing the skin to lift and new collagen to form. This technique is particularly useful for tethered boxcar scars. Punch excision, another surgical option, removes the individual scar with a small device and closes the wound, converting a depressed scar into a less noticeable linear scar. This method is often preferred for deeper, narrow boxcar scars.
Injectable fillers
Injectable fillers, such as hyaluronic acid, offer an immediate, albeit temporary, solution by plumping depressed areas of the scars. Fillers provide immediate volume, and some types may also encourage the body’s own collagen production over time.
Chemical peels
Chemical peels, which use acidic solutions to exfoliate the top layers of skin, can improve overall skin texture and reduce the visibility of shallower scars. Medium-depth peels like trichloroacetic acid (TCA) can be applied directly to the scar to promote skin cell turnover. Multiple sessions are often required across various treatment modalities, and while complete eradication is rare, significant improvement in scar appearance is achievable.