ACNE SCARS

What are acne scars?
Acne scars can occur in patients suffering from acne vulgaris.  Acne scarring occurs more commonly in severe forms of acne with large nodules and inflammation, such as nodulocystic acne.  If treated, the overall prognosis for persons with acne is good however in some cases it can lead to long-lasting psychosocial impairment and physical scarring.

How are acne scars formed?
To understand how acne scars are formed one must first understand the pathogenesis of acne.  Acne develops as a result of plugged follicles.  Hyperkeratinization and formation of a plug of keratin and sebum (a microcomedo) is the earliest change.  Enlargement of sebaceous glands and an increase in sebum production occur with increased androgen production during puberty. The microcomedo can enlarge to form an open comedone (blackhead) or closed comedone (whitehead).  In these conditions the naturally occurring bacteria called Propionibacterium acnes can cause inflammation, leading to inflammatory lesions (papules, infected pustules, or nodules) in the dermis.  This inflammatory reaction in the dermis results in redness and may eventually cause permanent scarring or hyperpigmentation.

How can acne scars be treated or minimized?
Preventing scar formation is the best practice, this can be done by routine acne treatment, avoiding picking, daily sunscreen use and using lotions with alpha-hydroxy acids.  Alpha hydroxy acids help remodel the skin. Once scars have formed several methods can be used for management. It is important to remember that once a scar is formed you cannot restore skin to its pre-scarred condition, therefore minimizing the appearance of scars is the goal of therapy.  Treatments are generally surgical/procedural and include:

  • Laser resurfacing: Best for shallow imperfections rather than “ice  pick” scarring. 
  • Dermabrasion: Best for shallow imperfections rather than “ice  pick” scarring. 
  • Chemical Peels: Best for very mild acne scarring.
  • Subcision: Can be used for most kinds of scarring.
  • Collagen augmentation: May be used for deeper scars.
  • Saline injections: May be used for shallow scars, less effective for deep scars.

References:
http://emedicine.medscape.com/article/1069804-followup 
The Patient’s Guidehttp://emedicine.medscape.com/article/1069804-followup 
http://en.wikipedia.org/wiki/Acne_vulgaris 
http://www.acnescars.com