Acne Imposters: Acne Scars
Sometimes acne scarring of one type or another is simply unavoidable. In fact, science still doesn't completely understand why some people get scarring and others don't, even if they had the same type of acne. And that includes why some acne scars fade over time and others remain. What is known is that there is often a genetic component (your parents probably have the same type of acne scars in the same general areas) and those with the most severe forms of acne (nodules and cysts, particularly) are often most susceptible to scarring.
Not every acne scar is permanent, however. Some people may get flat red marks that linger long after a papule or pustule has disappeared. These marks are called "macules", and even though they be visible for up to six months, they do go away.
Another type of "pseudo scar" is called post-inflammatory pigmentation. It's more common among people with darker skin tones, but anyone can get these discolored spots that remain while- and after- an inflamed acne lesion has healed. Dermatologists can help speed up the disappearance of these marks.
Not all acne scars disappear so easily, though. If you pick, scratch, or otherwise aggravate the affected areas you can turn a temporary pimple into a permanent mark. Best to keep your hands folded in your lap, walk away from the mirror, and let a professional handle any pimple popping for you.
There are two basic types of true acne scarring that are more serious, and need to be treated by a dermatologist: acne scars caused by increased tissue formation, and acne scars caused by tissue loss.
The former, called keloid or hypertropic scars, are less common and appear to be hereditary. These are found primarily in African-American, Asian and Latino patients. Keloid scarring occurs when the skin cells respond to injury by producing an excess of collagen, which forms into lumpy fibrous masses most frequently along the jaw line and on the back or chest. These acne scars appear firm and shiny, and may persist for years.
Acne scars caused by tissue loss are much more common, and may take many forms:
*Soft acne scars have gentle sloping rolled edges that merge with the surrounding skin. They are usually small, circular or linear in shape, and soft to the touch.
*Ice-pick acne scars. Most often found on the cheek, ice-pick scars are usually small but deep, with a jagged edge and steep sides. If they are soft to the touch, they may be improved by stretching the skin; hard ice-pick scars are difficult to treat.
*Depressed fibrotic acne scars. Over time, ice-pick scars may evolve into depressed fibrotic scars. These also have sharp edges and steep sides, but are larger and firm at the base.
*Atrophic macules, a form of acne scarring most common in Caucasians, are soft with a slightly wrinkled base. Blood vessels just below the surface of the scar may make them appear purplish when they are recent, but this discoloration may fade over time to a pale ivory.
*Atrophic macules are usually small when they occur on the face, but may be a centimeter or larger elsewhere on the body.
*Follicular macular atrophy is more likely to occur on the chest or back of a person with acne. These small, soft white lesions resemble whiteheads that didn't fully develop; they may persist for months or years.
How do you avoid acne scarring? The best defense is a good offense - stop the outbreaks dead in their tracks. That means treating the condition as soon as possible and as long as necessary. And the good news is that if you do develop acne scarring, there are plenty treatment options available, from dermabrasion to lasers. Talk to your dermatologist about which treatment is best for you.
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- Did you know acne is among the most common medical conditions? learn more