What Are Boxcar Scars? Is It Possible To Treat Them?

Written by Ramona Sinha

Severe acne or infectious disease like chickenpox can leave behind boxcar scars. These are the most common type of atrophic scars that look indented, sunken, or pitted and can be shallow or deep. Boxcar scars mainly form due to collagen damage during the healing process. They do not go away but may fade over time. However, several treatment procedures may help reduce their appearance to a great extent. This article discusses everything you need to know about boxcar scars and their treatment. Keep reading.

Recognizing Boxcar Scars

Recognizing Boxcar Scars 

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Boxcar scars are one of the three main types (and most common) of atrophic scars. About 20% to 30% of all atrophic scars are boxcar scars.

Boxcar scars can be shallow or deep. The shallow scars have a diameter between 0.1-0.5 mm and are much easier to treat, and the deeper scars are around 0.5 mm or more and may be resistant to treatment. The scars may appear as round or oval depressions, with clearly demarcated vertical edges (1).

Atrophic scarring mainly occurs when your skin is healing itself from severe acne or blisters left behind by chickenpox. The type of scarring also depends on how the wound site or lesions are healing. Let’s understand in detail.

How Do Boxcar Scars Develop?

The skin has several layers, and the key components of skin healing – collagen and elastin – form in the dermis, the second layer. Boxcar scars form when a severe injury affects the skin’s deep layers, and it cannot produce enough collagen to cover the injury site, and the area develops irregularities.

You may develop boxcar scars if you:

  • Have severe forms of acne, such as papules, pustules, and nodules.
  • Squeeze, pop, and scratch the lesions.
  • Do not treat acne lesions.
  • Are recovering from chickenpox.

Based on how your skin heals, you may notice boxcar scars (or a mix of different scar types) on your face, particularly on the cheeks and the lower jaw. Shallow boxcar scars may fade away over time and are easier to treat. However, deeper scars may take time to heal.

Do Boxcar Scars Go Away? How To Treat Them

No. Boxcar scars do not go away. In fact, the older you get, the more pronounced they might look due to lesser collagen production. However, there are multiple ways to treat boxcar scars and improve their appearance. They include:

1. Chemical Peels

Peels are a generalized approach to treating atrophic scars. They involve using a chemical on the skin that destroys the outer layer, accelerating the exfoliation process, leading to tissue remodeling. This helps reduce the scar’s appearance over time.

It is an in-office procedure, and the strength depends on the scar depth and skin tolerance levels. Chemical peeling can leave your skin vulnerable to UV damage. So avoid sun exposure right after peeling and use sunblock and protective clothing to prevent chances of hyperpigmentation (2).

Best For: Shallow boxcar scars and post-inflammatory hyperpigmentation

2. Dermabrasion

Dermabrasion involves using a device to remove the top layer of the skin. This method allows the dermatologist to precisely define scar edges.

For this procedure, the skin is numbed before treating. You may notice blotchy and swollen skin and redness for a while after the procedure. However, they subside after a few days. Dermabrasion helps improve the skin texture and appearance of scars. However, you may have to undergo multiple sessions for better results.

Best For: Shallow boxcar scars

3. Microneedling

This method involves pricking the skin with tiny needles to induce collagen and elastin production. This is also known as collagen induction therapy regrowth and is performed under the doctor’s supervision, under topical anesthesia. The number of sessions depends on the severity of the scars and how your skin is healing (1).

Microneedling is often combined with platelet-rich plasma (PRP) to provide cosmetic improvements. PRP is a concentrate of platelet-rich protein derived from the patient’s blood. It is used in conjunction with the needling to improve the scars (1), (3).

Best For: Moderate to deep boxcar scars

4. Radiofrequency

This therapy delivers current through the dermis to stimulate collagen production to soften the look of scars. Radiofrequency can be used as a monotherapy or with fractional lasers to smoothen the skin texture.

Radiofrequency requires the use of a numbing agent and has a longer downtime than microneedling. You can see 25%-75% improvement after 3-4 sessions, and results are optimal three months after the final session (1).

Best For: Moderate to deep boxcar scars

5. Ablative Lasers

These are the big guns for scar treatments and give significant results after just one session. They show about 75% improvement in atrophic scars at 18 months after the laser treatment. However, they have the longest downtime and greater chances of adverse effects like infection, pigmentation issues, and discomfort (3).

The dermatologist may put you on antibiotics before treating your boxcar scars with ablative lasers. There are different kinds of ablative lasers, and the most common are the CO2 laser and Erbium laser.

Best For: Moderate to deep boxcar scars

6. Non-Ablative Lasers

These are newer forms of laser treatments that reduce the downtime post-treatment compared to ablative lasers. They also reduce the risk of damaging the upper skin layer. This is because non-ablative lasers deliver photothermal energy to the inner layers to stimulate the fibroblasts (cells producing collagen and elastin). Non-ablative lasers are much tolerable and have a short recovery time. However, the results are not often clinically impressive.

Best For: Shallow to moderate boxcar scars

7. Fillers

Dermal fillers are injected into the skin layers to improve the appearance of the depressed scars. There are three types of fillers (1):

  1. Temporary Fillers: These are hyaluronic acid fillers and may last for a few months. You may need frequent sessions to maintain the skin’s appearance.
  2. Semi-Permanent Fillers: These are biostimulatory (stimulate fibrous tissue formation) and show significant improvement in boxcar scars. These fillers may last for up to 2 years.
  3. Permanent Fillers: They can last up to 10 years and even for a lifetime. But they may move from the initial targeted area over time. They also come with the risk of side effects and may often require complete removal. Silicone or synthetic fillers like polymethylmethacrylate (PMMA) fillers are used for correcting the appearance of scars as these are affordable and stable.

Best For: Moderate to deep boxcar scars

8. Punch Excision

This method involves using a punch instrument to puncture the area of the scar. After that, the scar tissue or inner layer is removed, and the wound is stitched. This method is known to work well with laser resurfacing.

Best For: Deep boxcar scars

9. Punch Elevation

In this method, after puncturing the scar with the punch instrument, the tissue is elevated and stitched slightly above the surrounding area. This contracts the wound and improves the appearance of wide boxcar scars.

Best For: Broad boxcar scars

10. Chemical Reconstruction Of Skin Scars (CROSS)

This technique involves using a high-strength trichloroacetic acid (TCA) peel at the base of the scar. This degrades the epithelial cells in the skin and stimulates skin remodeling.

TCA can promote the healthy production of collagen to diminish scars. This method provides satisfactory results in about 3 to 6 sessions (1), (3).

Best For: Narrow boxcar scars

If you have minor scarring, you can improve its appearance by using at-home treatments. But if it is moderate to severe, it is best to consult a professional for personalized treatment and optimal results as per the skin type and scar depth.

Takeaway

Boxcar scars on the face can make you conscious about your appearance. The best way to prevent scarring is by treating acne (or other skin issues) as per the doctor’s advice. Proper treatment and healing can reduce the risk of deeper scars. Otherwise, you can consult a doctor and opt for any of the treatments mentioned above, suitable for your scar and skin type.

Frequently Asked Questions

How to get rid of boxcar scars without treatment?

Shallow scars may fade without treatment, but moderate to deep scars may not.

3 Sources

Articles on StyleCraze are backed by verified information from peer-reviewed and academic research papers, reputed organizations, research institutions, and medical associations to ensure accuracy and relevance. Read our editorial policy to learn more.

  1. Acne Scarring—Pathogenesis Evaluation and Treatment Options
    https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5749614/
  2. A systematic review of treatments for acne scarring. Part 1: Non-energy-based techniques
    https://journals.sagepub.com/doi/pdf/10.1177/2059513117695312
  3. Review on the treatment of scars
    https://parjournal.net/article/view/3773

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Ramona is a journalist-turned-content writer. She holds a Master’s degree in English Literature and has been writing for the digital world for over five years. She specializes in writing for Skin Care. She has done a certificate course titled ‘Dermatology: Trip To The Skin’, offered by Novosibirsk State University. She believes that beauty begins with a good skin care regimen and is on a mission to eliminate all toxins from her routine. She helps and guides readers in selecting products and ingredients specific to their skin type/issue. When Ramona is not working, her books and passion for music, good food, and traveling keep her busy.