The Pathophysiology of Acne Scars
Acne scars are alterations in normal skin structure that occur as a result of abnormal, or pathophysiological, changes associated with the development of moderate or severe acne. The scars are unusually raised or lowered areas in the skin. Although doctors understand many of the mechanisms associated with acne scarring, they cannot predict who will develop this condition.
Acne occurs when the combined effects of excessive skin oil, clogged pores and skin bacteria trigger inflammation at various depths within the skin, according to the American Academy of Dermatology. The severity of acne largely depends on the location of this inflammation. Inflammation close to the surface typically produces less severe blemishes, such as whiteheads and blackheads. Inflammation at a deeper level produces common pimples or pus-filled pimples called pustules. Inflammation at a still deeper level causes severe acne lesions called cysts or nodules. Roughly 30 percent of those with moderate or severe inflammation develop scars, the New Zealand Dermatological Society reports.
Types of Scarring
In some cases, acne scarring stems from the increased production of a protein called collagen, the Academy of Dermatology reports. This increase promotes the formation of raised, thickened marks, called hypertrophic scars, or an excessive growth of scar tissue called keloids. But in most cases, the changes associated with acne produce scars involving the loss of normal tissue. Depending on your particular situation, skin injuries in this category may include large marks called depressed fibrotic scars, narrow marks called ice-pick scars, deep or superficial soft scars or flat, soft discolored scars called atrophic macules.
Scarring often occurs in those who have a severe form of acne called acne conglobata, according to the New Zealand Dermatological Society. Those with this disorder have inflamed acne nodules that grow larger and eventually break down and release pus, leading to the formation of ulcers underneath the nodules. In turn, this process can result in the formation of interconnected abscesses that run under the skin and trigger the formation of significant scarring. Acne conglobata most commonly occurs in men ages 18 to 30, according to the Academy of Dermatology.
Scarring also commonly occurs in those who have a form of acne called acne fulminans, the New Zealand Dermatological Society notes. In addition to the severe, ulcerating acne associated with acne conglobata, symptoms of this disorder include fever, pain and inflammation in joints such as the knees and hips. Depending on your circumstances, you may develop acne fulminans in the aftermath of ineffective treatment for acne conglobata, according to the Academy of Dermatology.
You have an increased risk of developing acne scars if the condition runs in your family or if you have had any form of severe acne, according to the Academy of Dermatology. But your doctor cannot determine in advance whether you will develop scarring. To prevent or reduce the possibility of scarring, seek early, effective treatment for all forms of acne.
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