Acne Scars: Their formation

An acne scar can result from skin damage caused by healed acne lesions. The types of acne scars are as varied as the types of acne lesions. This variety arises because of the multiplicity of ways an acne lesion can form.

For example, an acne lesion may originate deep within the fatty tissues of the skin as the in the case of cysts or nodules. Then again, the acne lesion may for just beneath the epidermis as a result of pore irritation.

The origination of the acne lesion within the skin will impact if and how an acne scar forms.

Another factor that shapes the development of an acne scar is how the lesion was treated. If an acne patient prematurely “pops” or opens and acne lesion, this could result in acne scar.

Types of acne scars

Atrophic Acne Scars
Hypertrophic (Raised) Acne Scars
Pigmented Acne Scars

In November of 1999, the British Journal of Dermatologypublished a study on the effectiveness of laser resurfacing to treat an acne scar. The study designers defined two types of acne scars, atrophic (“ice-pick”) scars and raised acne scars. Additionally, acne patients may experience flat, pigmented acne scars.

Atrophic Acne Scars

An atrophic acne scar appears as round indented marks on the skin. Their size can range from 0.254mm to 2.540mm in diameter. The dept of an atrophic acne scar can vary between 0.254mm to 0.762mm.

An acne lesion can start as a non-inflamed closed comedone (pore blocked by excess oils, keratin and/or skin cells).

As the comedone becomes inflamed by inflammatory response caused by excess bacteria and free fatty acids, the size of the irritated pore can increase.

Once the inflammation is removed, the acne lesion can begin the healing process.

According to review of acne scar pathology Greg J. Goodman published in the 2001 edition of the Australian Journal of Dermatology, the skin indentations associated with atrophic acne scars typically results from the contraction of surface layers.

The depth and width of an atrophic acne scar is caused by the loss of collagen, and sometimes fat loss, resulting from the healed acne lesion.

Hypertrophic (Raised) Acne Scars

Raised acne scars are less common than “ice-pick” type acne scarring. Hypertrophic scars look like keloids- raised scars that continue to grow even after the area has healed. However, hypertrophic acne scars do not reach the large size that keloids reach, and hypertrophic acne scars are easier to treat the keloids. Hypertrophic acne scars may fade over time.

Pigmented Acne Scars

A number of acne lesions can form, or move, to the surface of the skin. Such acne lesions include blackheads and pustules (pus-filled acne lesion on the surface of the skin).

Due the unwanted presence of such lesions on the face, acne patients are tempted to burst or squeeze such lesions.

Since these acne lesions are closer to the upper layer of the skin than deep acne lesions like cyst, pustules and blackheads generally do no leave indented acne scars because their anti-inflammatory healing process will involve less collagen repair and little is any fat loss.

Because acne lesions are on the surface of the skin, their repair will involve the build-up of skin scales to repair the opened wound. The build-up of skin cells concentrates the brown skin pigment melanin, which creates the circular brown acne scar.

Photo Credit: Elle Hughes from natural women collection

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