Acne scarring: an update inclusive of our research
More than half of those with acne can also develop acne scars. Acne scars can be seen across the spectrum of acne severity.
Acne scars are defined as those developing from preceding acne and that are due to loss or increased skin volume. They do not refer to brown or red stains, otherwise known as macular pigmentation or erythema. Most acne scars are atrophic (from loss of volume) while a minority are due to increased volume, otherwise known as hypertrophic or keloidal scars. The most sensitive way to detect scars is to evaluate the surface with tangential lighting which will shadow the indentations from atrophic scars and the elevations from hypertrophic scars.
Acne scars can be extremely bothersome for those affected as they can be readily apparent, long-term and persistent. Furthermore, those with acne scars can be stigmatized or perceived in a negative manner by people around them.
Prior research has shown that majority of acne scars result from red, inflamed acne pimples technically known as papules, pustules, or nodules. They rarely develop from comedones, technically known as whiteheads and blackheads.
The greatest risk of acne scarring is in those with more severe acne, longer duration of acne before treatment, those with a family history of scarring, and in those who manipulate/ squeeze their pimples.
Of newly formed scars, almost 1/3 are transient and may heal spontaneously. Scarring is due to the intensity and duration of inflammation from the acne spots. resolution of scars results from the balance of ongoing matrix damage to the underlying structure versus matrix repair. In the latter, fibroblast activation is required in forming more collagen, elastic tissue and glycosaminoglycans including hyaluronic acid.
Of primary importance in reducing scarring risk is effective and timely treatment of acne. The use of skin creams containing topical retinoids may help improve not only acne but also acne scarring as they increase collagen formation, helpful in repair of acne scars.
In the next section, I will discuss in further detail acne scar repair options.