Scarring

Acne scars represent the visible after effects of acne lesions.  When body tissue suffers an injury, the body reacts by rushing to repair the injury site.  In the case of acne scars, the scar is created when the body generates new collagen or melanin in response to the acne infection.

How and why some people scar and others do not is not completely understood. Two individuals with similar acne lesions can have marked differentiatial acne scarring.  This considerable variation between individuals suggests that some people are simply more prone to acne scarring than others.  Those that are susceptible to acne scars often have a genetic link - the degree to which they scar and the kind of scar they get often "runs in the family." Acne scars have considerable variation in their “life cycle”.  While some of us bear acne scars for a lifetime with little change, others see their scars diminish over time.

One fact is certain, acne scarring occurs most frequently in patients with the most severe forms of inflammatory acne, involving deep, cystic and nodular lesions.  Because little is known about what causes one person to scar more easily than another, the best way to avoid scarring is to effectively treat the acne condition that causes scarring early in its development.

One of the most important factors in acne scar formation is inflammation.  The more inflammation you can prevent, the less likely you are to scar.  In the event that acne lesions do develop, treating them with the proper medication, lasers or over the counter products - rather than squeezing or picking them - will limit the risk of acne scarring.  Squeezing pimples with fingernails or poking them with a pin significantly increases the damage to surrounding tissue which increases imflammation and the incidence of scarring.

Types of acne scars.

There are several types of acne scars, but two general categories.  There are those scars that are formed by tissue loss (or gain) and the subsequent collagen generation and tissue fibrosis and those caused by coloration changes in the skin (post traumatic hyperpigmentation). 

For scars formed by tissue fibrosis and collagen generation, there are several shapes.  The shape of the acne scars depends on the type of lesion that the scar was formed in response to, whether or not the lesion became aggravated and inflamed from picking, and the individual's healing response.

Soft scars.  These scars have gentle, sloping and rolled edges that merge into surrounding skin. They are usually small, circular or linear in shape, and are soft to the touch.

Ice-pick scars.  Icepick scars are narrow, sharp scars that make the skin appear it has been punctured with an icepick. They are usually narrower than 2 mm and extend into the deep dermis or subcutaneous layer.  Most often found on the cheek, ice-pick scars are usually small but deep, with a jagged edge and steep sides.

Depressed fibrotic scars.   Depressed Fibrotic scars are usually quite large, with sharp edges and steep sides. The base of these acne scars is firm to the touch. Over time, ice-pick scars may evolve into depressed fibrotic scars. These also have sharp edges and steep sides, but are larger and firm at the base.

Atrophic macules, a form of scarring most common in Caucasians, are soft with a slightly wrinkled base. Blood vessels just below the surface of the scar may make them appear purplish when they are recent, but this discoloration may fade over time to a pale ivory. Atrophic macules are usually small when they occur on the face, but may be a centimeter or larger elsewhere on the body.

Keloid Scars.  Keloid or hypertropic scars, are less common and appear to be hereditary. They are found primarily in African-American, Asian and Latino patients.  Keloid scarring occurs when the skin responds to injury by producing an excess of collagen.  The excess collagen forms into lumpy fibrous masses that are seen most frequently along the jaw line or on the back and chest. These scars appear firm and shiny, and may persist for years.  They may also extend beyond the original wound and often appear darker or redder than the surrounding skin.  Keloids may develop months after injury and may enlarge without treatment. 

The second category of acne scarring involves pigmentation (color) changes to the skin.  This type of acne scarring, also called traumatic hyperpgimentation, manifests itself as redness in caucasians and dark spots (melanin related) in darker individuals such as Hispanics, Asians and African Americans, color changes are related to the development of melanin in response to the infection.  Because the skin produces melanin in response to the inflammation, these scars can sometimes take months or years to resolve.

Macules.  As an acne blemish heals, the inflamed area flattens, leaving behind a reddish spot.  Though it may look like a scar, it’s actually a macule, which is the final stage of an acne lesion. Although macules may last for months, they leave no permanent scar. 

Melanocytic Post Inflammatory Hyperpigmentation.  For Hispanics, Asians, and African Americans, the bodies response to an infected acne lesion often involves the production of melanin.  The inflammation associated with acne lesions causes darkening of the skin at the healing site.  Although the coloration changes are not permanent, they can often last for months or even years.  Click here for more information on hyperpigmentation.

Acne Scar treatment Options

Although acne scars can be difficult to treat, there are options.  For those that are just developing acne scars, the best treatment is to prevent the further development of acne lesions.  To learn more go to acne treatment options.

For those that already have acne scars, there are several treatment options.  They include dermabrasian, subcision, laser resurfacing, deep chemical peels, collagen injection and punch surgery.  To better understand surgical and non-surgical options, contact a local acne physician.