Acne Scarring

Two types of true scars exist

  • Depressed areas such as ice-pick scars,
  • Raised thickened tissue such as keloids.


Macules or “pseudo-scars” are flat, red or reddish spots that are the final stage of most inflamed acne lesions. After an inflamed acne lesion flattens, a macule may remain to “mark the spot” for up to 6 months. When the macule eventually disappears, no trace of it will remain—unlike a scar.


acne-scarring

Post-inflammatory pigmentation is discoloration of the skin at the site of a healed or healing inflamed acne lesion. It occurs more frequently in darker-skinned people, but occasionally is seen in people with white skin. Early treatment by a dermatologist may minimize the development of post-inflammatory pigmentation. Some post-inflammatory pigmentation may persist for up to 18 months, especially with excessive sun exposure. Chemical peeling may hasten the disappearance of post-inflammatory pigmentation.

Causes of Acne Scars

In the simplest terms, scars form at the site of an injury to tissue. They are the visible reminders of injury and tissue repair. In the case of acne, the injury is caused by the body’s inflammatory response to sebum, bacteria and dead cells in the plugged sebaceous follicle.

When tissue suffers an injury, the body rushes its repair kit to the injury site. Among the elements of the repair kit are white blood cells and an array of inflammatory molecules that have the task of repairing tissue and fighting infection. However, when their job is done they may leave a somewhat messy repair site in the form of fibrous scar tissue, or eroded tissue.

White blood cells and inflammatory molecules may remain at the site of an active acne lesion for days or even weeks. In people who are susceptible to scarring, the result may be an acne scar. The occurrence and incidence of scarring is still not well understood, however. There is considerable variation in scarring between one person and another, indicating that some people are more prone to scarring than others. Scarring frequently results from severe inflammatory nodulocystic acne that occurs deep in the skin.

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