Acne Scars
Acne scars are the one complication of acne which people really fear. Acne scarring occurs in only a small proportion of acne patients, typically those with severe acne or those who suffer from one of two very rare clinical types of acne, keloid acne and acne conglobata. The dual aims of acne management are to prevent the formation of acne scars in those with active acne and to eradicate acne scars in those patients who have previously developed scarring.
What Are Acne Scars?
Any significant trauma to the skin which damages the integrity of the skin's surface layer, for example a cut or graze, will heal to leave a scar. Acne scars are exactly the same as other scars, except that in the case of acne the skin is being being traumatised from within, rather than being damaged from outside. As the damaged skin heals, new material, known as scar tissue, forms to 'fill the gap' in the skin's surface caused by the trauma. Skin and scar tissue are made of quite different materials, which is why scars are visible on the surface of skin. Scar tissue contains lots of a connective tissue called collagen, which can be laid down quickly and so speed up the healing process. Most scars look shiny compared to the surrounding normal skin because of their high connective tissue content, but may appear either lighter or darker than surrounding skin. Whether the scars are raised, level with the skin's surface or sunken will depend on both the type and extent of the injury and the way in which it has been treated.
Cause of Acne Scars
Acne scars are the result of trauma within the skin caused by certain types of acne spots. Spots which cause acne scarring are those which damage the integrity of the outer layer of skin, known as the epithelium. Cystic acne requires intensive and often prolonged treatment, usually with antibiotic drugs Blackheads and pustules form raised spots with an open centre, which will heal and 'close over' with the formation of scar tissue. Not all blackheads and pustules will heal to leave permanent, visible acne scars, but all will heal by a process which involves the formation of scar tissue and so have the potential to cause permanent acne scarring. Cystic acne is a complication of acne in which deep inflammatory lesions form beneath individual acne spots. Each acne cyst is a spongy mass of inflammatory material extending deep into the skin, which opens onto the skin's surface as a large pustule. Acne cysts are typically one to two centimetres in diameter, domed, appear an 'angry red' colour and are often tender. Cystic acne requires intensive and often prolonged drug treatment and almost invariably resolves to leave pitted acne scars. In contrast, papules and whiteheads are raised acne spots in which the surface of the skin remains intact and so resolve without significant danger of acne scarring.
Rare Types of Acne Scarring
There are two rare types of acne which produce really quite spectacular types of acne scarring. Sufferers from either condition are likely to be so alarmed by the appearance of the scars that they rush to see a doctor, Acne conglobata is a rare type of acne seen most often in males around the age of 20 which is absolutely the correct course of action. Keloid acne is a variant of acne in which the scar forming mechanism goes into overdrive and produces firm, raised, smooth plaques of scar tissue instead of neat, circumscribed scars. These collagen rich plaques are large, often five to ten centimetres accross, and of similar colour to the normal skin. Keloid acne scars are often mistaken by patients for rapidly developing skin tumours, for that in many respects is what they most resemble. Acne conglobata is a horrendous form of acne which occurs most frequently in males around the age of 20. The patient's back becomes covered in a mass of huge suppurating acne cysts which will eventually heal to leave large pink translucent scars, often referred to as 'tissue paper' acne scars. Some people with acne conglobata have an associated XY chromosomal abnormality. Keloid acne and acne conglobata are both rare conditions which require treatment by a medical specialist. The remainder of this section deals with the prevention and treatment of acne scarring which may result from severe acne of the other clinical types, particularly when it is complicated by the development of cystic acne.
