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What Causes Acne Scars?

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Updated June 19, 2014

Question: What Causes Acne Scars?
Answer:

Scars result from a wound or injury. Scars, however unwelcome, are part of the skin's normal healing process. Generally, superficial wounds heal without scarring. It is when the dermis is damaged that scars form on the skin.

Acne scars are most often the product of an inflamed lesion, such as a papule, pustule, or cyst. Inflamed blemishes occur when the follicle, or pore, becomes engorged with excess oil, dead skin cells, and bacteria. The pore swells, causing a break in the follicle wall. If the rupture occurs near the skin's surface, the lesion is usually minor and heals quickly. More serious lesions arise when there is a deep break in the follicle wall. The infected material spills out into the dermis, and destroys healthy skin tissue.

To repair the damage done to the dermis, the skin forms new collagen fibers. Collagen is the fibrous protein that gives the skin its strength and flexibility. Unfortunately, the finished "repair job" never looks as smooth and flawless as before the injury.

As the wound heals, the body sometimes produces too much collagen, which creates a mass of raised tissue on the skin's surface. This type of scarring is called hypertrophic, or keloid, scarring.

More commonly, acne causes atrophic, or depressed, scars. Atrophic scars develop when there is a loss of tissue. Ice pick and boxcar scars are two examples of atrophic scars.

Inflammation is the single greatest gauge of scar development. The greater the inflammation on the skin, the more likely scarring is to occur. Deep breakouts that take a long time to heal also increase the chance of scarring. Blackheads, whiteheads, and other non-inflamed blemishes typically don't cause scarring because these types of lesions don't injure skin tissue.

Often, what is taken to be an acne scar is not a true scar at all, but rather post-inflammatory hyperpigmentation (PIH). This temporary discoloration of the skin will eventually fade on its own. Certain treatment medications, such as Retin A, may speed fading time.

Scar Prevention

To lessen the chance of scarring, try to reduce inflammatory breakouts as much as possible. This may mean you have to consult with a dermatologist to help get your acne under control.

Pass up the temptation to pick or squeeze a pimple. Doing so can force debris deeper into the dermis, spreading infection to other tissue and worsening inflammation. Picking at scabs should also be avoided. A scab is the skin's natural "bandage" which protects the wound as it heals. Picking a scab off a wound before it is ready prolongs the healing process and increases chances of scarring.

Even with the most careful treatment, you may develop acne scars. There are procedures that can help minimize the appearance of scarring. If scarring is a concern of yours, don't hesitate to talk to your doctor. He or she can explain the treatment options available to you.

Sources:

Gerson, Joel; Ph.D. Standard Textbook for Professional Estheticians. 8th edition. Albany, NY: Milady Publishing, 1999.

Jacob CI, Dover JS, Kaminer MS. "Acne scarring: a classification system and review of treatment options." Journal of the American Academy of Dermatology (2001); 45(1):109-117.

"What is a Scar?" American Academy of Dermatology. 2005. American Academy of Dermatology. 29 Sep 2007.

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