Boxcar Scars

Box scars, commonly known as boxcar scars, are a type of atrophic scar characterized by their distinct, pitted appearance. Unlike other types of scars, boxcar scars have sharply defined edges and a flat base, often resembling the scars left by severe acne or other skin injuries. These scars can significantly affect an individual’s self-esteem and quality of life, making understanding their causes and treatments essential for both medical professionals and patients.

Here at FMS Skin and Hair Clinics, After proper examination by our expert dermatologists, we recommend a customized treatment depending on the extent of the scar and the severity of the scars. 

BOXCAR SCAR TREATMENT AT FMS— A combination of procedures are usually advised. Can be started with MNRF and Fractional lasers along with bio stimulators. Multiple session are required for a better result.

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Door No. 8-2-293/82/A/725/A, Beside FMS
Hitech City Rd, near Daspalla Hotel, CBI Colony,
Jubilee Hills, Hyderabad, Telangana 500033

Characteristics of Boxcar Scars

Box Scars at FMS SKIN

Appearance:  These scars are broad, usually box like depressions with sharply defined edges and flat base. They resemble the letter ‘U’

Location: These scars are often found on the lower cheeks and temples, areas where the skin is thicker and more prone to deep, cystic acne.

Causes of Boxcar Scars

  1. Acne Vulgaris: The most prevalent cause of boxcar scars is severe acne, particularly cystic acne. When acne cysts burst, they damage the surrounding skin tissue, leading to the formation of scars as the skin heals. The inflammation associated with acne triggers a response that can destroy collagen, creating a depression in the skin.
  2. Chickenpox: Another common cause is chickenpox, a viral infection that can leave lasting scars. The blisters from chickenpox can form deep scars if they are picked or scratched, leading to boxcar-like depressions.
  3. Injuries and Surgery: Physical trauma to the skin, such as cuts, burns, or surgical incisions, can also result in boxcar scars. When the skin heals after such injuries, the collagen may not regenerate evenly, causing pitted scars.
  4. Genetic Predisposition: Some individuals may be genetically predisposed to scarring. Their skin might be more prone to forming boxcar scars due to a familial tendency towards poor wound healing or collagen disorders.

Treatments for Boxcar Scars at FMS Skin & Hair Clinics

Treating boxcar scars involves a multifaceted approach tailored to the severity and depth of the scars, as well as the patient’s skin type and overall health. The most common and effective treatments include:

Topical Treatments

At-Home Treatments

  1. Topical Retinoids: Retinoids are derivatives of Vitamin A that promote cell turnover and collagen production, helping to improve skin texture and reduce scarring. 
  2. Alpha Hydroxy Acids (AHAs): Chemical exfoliants usually help in removing dead skin cells and stimulate new cell growth. Incorporating AHA products into your skincare routine 2-3 times a week to improve skin texture and reduce the appearance of scars. Examples: Glycolic acid (AHA)
  3. Vitamin C Serums: An antioxidant which to brighten the skin, reduce hyperpigmentation, and boost collagen production. Applying a Vitamin C serum in the morning helps to improve overall skin tone.


Professional Treatments

  1. Chemical Peels:  Chemical peels involve applying a chemical solution to the skin to remove the top layers, promoting new skin growth. Medium to deep peels, using trichloroacetic acid (TCA) or phenol, can significantly improve the appearance of boxcar scars by promoting collagen remodeling and skin resurfacing.
  2. Radiofrequency (RF) Treatments: Uses radiofrequency energy along with tiny fine needles which create micro-injuries in skin, which heat the deeper layers of the skin, stimulating collagen production and skin tightening. Microneedling RF, fractional RF etc are effective for both texture improvement and reducing pigmentation. Recovery time typically ranges from 1-3 days of redness and mild swelling.
  3. Laser Therapy: It uses focused energy beam of light to produce controlled damaged on the acne scars which helps them to resurface and also helps in stimulating collagen production. Fractional lasers like CO2 laser, and erbium laser are effective for atrophic scars. Multiple sessions are required for best results. Recovery time varies from 5-10days depending on the type of laser used.
  4. Punch Techniques : Punch Excision –This surgical technique involves removing the scarred tissue entirely with a small, cookie-cutter-like tool. The resulting wound is then closed with stitches or left to heal naturally.  Punch Grafting: Similar to punch excision, but instead of stitching, a skin graft (usually taken from behind the ear) is placed in the excised area. 
  5. Dermabrasion and Microdermabrasion: Dermabrasion –This procedure involves sanding down the top layer of skin to promote the growth of new, smoother skin. It’s more aggressive and can be effective for superficial ice pick scars but requires significant downtime. Microdermabrasion: A less invasive procedure that exfoliates the skin using tiny crystals. While less effective for deep ice pick scars, it can improve the overall texture of the skin and be used in conjunction with other treatments.
  6. Bio Remodelling Therapy: PRP/GFC therapy involves using a concentration of the patient’s own platelets to promote healing and collagen production. These can be injected directly into the scar or they can be also applied on the surface of skin after microneedling to enhance the results.

Boxcar scars, with their distinctive appearance and potential psychological impact, require a comprehensive and personalized approach to treatment. From topical treatments and chemical peels to advanced laser therapies and surgical interventions, numerous options are available to reduce their appearance and improve skin texture. The choice of treatment depends on various factors, including the depth and severity of the scars, the patient’s skin type, and their overall health. Consulting with a dermatologist or skin care professional is crucial to develop a tailored treatment plan that addresses individual needs and achieves the best possible outcomes.