Types of Acne Scars:
The dreaded complication of acne for any teenager, the acne scars, can present as different types depending upon the depth and tissue response to the inflammation.
- Deep Acne Ice Pick Scars.
Classifying acne scars into different types is important in planning an appropriate mode of treatment. Superficial acne scars can be treated with topical exfoliants and chemical peels while deep scars may require surgical intervention.
Acne scars could also be classified, depending upon the extent of involvement, as localized, scattered or extensive. Very superficial scars, on effective treatment of the acne, are temporary as the scars fill out and gradually disappear over time without any treatment. Most of the deep and medium depth acne scars are, unfortunately, permanent. The types of scars formed depend upon the types of acne, its extent and severity.
Brown or dark spots and other skin blemishes after a bout of acne eruptions are not acne scars as there are no structural changes in the skin layers, just skin discoloration in such cases.
Atrophic Acne Scars-Types of Acne Scars
Atrophic acne scars are depressed scars formed by loss of tissue beneath the upper layer of the skin. The skin literally settles down due to lack of support in the dermis forming pitted scars known as acne pits, as the dermal tissues are damaged following delayed or improper treatment of active acne lesions. The skin shows signs of atrophy, viz, thinning, loss of skin markings and shininess. The following are the main types of atrophic scars seen in acne:
- Acne ice-pick scars get their name from their resemblance to ice pick wounds- these are narrow, punctiform scars with steep sides. Ice pick acne scars may be shallow or deep, about one to two millimeters in diameter. The opening is typically wider than the inner base, forming a “V” shape. Some scars may feel hard to the touch, while others are soft in consistency.
- Boxcar acne scars resemble chickenpox scars with sloping edge. They are wider at the surface without the tapering base as seen in ice pick scars. They can also be superficial or deep and soft or firm.
- Rolling atrophic acne scars form due to the adherence of the dermis to the subcutaneous tissue. Usually they are wider than four to five millimeters and present with an undulating or rolling surface, forming a flat wavy “M” shaped scar.
- Macular atrophic acne scars: Rarely found on the face, macular atrophic acne scars are seen on the body as small, flat, thin scars with a shiny, papery-white appearance. Color of the scars may be light brown, bluish or violaceous. These scars will respond to application of exfoliants like alpha hydroxy acids or topical retinoids. Macular atrophic scars gradually fade away within a few months even without any active treatment.
Hypertrophic Acne Scars
These are acne scars produced as a result of tissue regeneration in response to dermal injury caused by inflammatory acne. The scars are soft to firm in consistency, raised and pink or skin colored in appearance. Some of these hypertrophic acne scars are painful, and, sometimes, itchy.
Keloidal Acne Scars
At times, in individuals with a keloidal tendency, hard, keloidal scars may occur as a complication of acne. They are reddish purple in color and present as bumps and humps, especially in dark skinned individuals. In contrast to hypertrophic scars, the keloid scars tend to grow continuously and beyond the edge of the original acne scar. An inherent mechanism limiting tissue regeneration is faulty in individuals with keloids.
Hypertrophic and keloidal acne scars typically occur on the torso, i.e. the upper and middle aspect of the back and chest, shoulders and the neck including the lower jaw. In contrast, the atrophic scars occur predominantly on the face, and rarely, if ever, on the back.
The treatment of acne scars includes medical or conservative and surgical or cosmetological interventions. Acne scar remedies available OTC or on prescription are all limited in their usefulness in that they are effective only for superficial macular type of atrophic acne scars. Acne scar home remedies using the AHA containing fruit juice extracts also have similar limitations and are not effective in all types of acne scars.