Acne Scars

Acne scars (ICD-10-GM L90.5: scars and fibrosis of the skin) are postinflammatory hyperpigmentation. They develop as a result of very severe forms of acne, such as so-called acne indurata and acne conglobata, and in some cases become visible years later. Course and prognosis: Especially when acne scars occur on the face, those affected suffer greatly. With adequate therapy, an improvement in the skin‘s appearance can be achieved. However, complete restitution (recovery) is not to be expected.

Classification

A distinction is made between atrophic, sunken scars, and hypertrophic, protruding scars. Atrophic acne scars are the most common. Classification of acne scars:

Atrophic scars Hypertrophic scars
Type Description Type Description
Atrophic macular scars
  • Erythematous (associated with a reddening of the skin).
  • Hyperpigmented or hypopigmented
  • Often folded like cigarette paper
 Perifollicular papular scars(perifollicular elastolysis).
  • Levaceous, dermal, whitish or skin-colored nodules resembling closed comedones
Worm-like scars(Icepick scars, V-shaped scars).
  • Diameter <2 mm
  • Funnel-shaped, as if knocked out with an ice pick
  • Deep, steep-walled, reaching into the lower corium (dermis) or subcutis (hypodermis)
 Bridge scars
Varioliform scars(Boxcar scars, U-shaped scars).
  • Diameter 1.5-4 mm
  • Shallow (0.1-0.5 mm) or deep (≥ 0.5 mm)
  • Round or oval
  • Steep-walled, reminiscent of chickenpox scars
 Keloids(bulge scar)
Wavy scars(Rolling scars, M-shaped scars).
  • Diameter > 4-5 mm
  • Flat
  • Corium connected to the subcutis by strands of connective tissue, giving the skin surface a wave-like appearance

Multiple types of scars may occur in a single affected person.

Symptoms – complaints

Acne scars are usually reddish at the beginning, because they are supplied with blood more than the rest of the skin.After a few weeks to months, the blood flow normalizes and thus the redness also recedes. Localization:The facial and upper trunk areas are particularly affected.

Pathogenesis (disease development) – Etiology (causes)

In acne, the sebaceous glands in the skin are stimulated to grow more and secrete too much sebum. There is also increased keratinization of the skin at the excretory ducts of the sebaceous glands, so that the sebaceous glands become clogged. Bacteria find an ideal breeding ground in the accumulated sebum. They multiply and eventually lead to inflammation of the sebaceous glands. The inflamed sebaceous glands appear as reddened and painful acne nodules. When this inflammation eventually spreads to other areas of the skin, troublesome acne scars appear.

Consequential diseases

  • Scratching or squeezing pimples or pustules (pustules) promotes scarring.

Diagnostics

Acne scars are detected by visual diagnosis.

Therapy

There are now numerous ways to treat acne scars:

  • Individual sunken scars can be injected using fat or hyaluronic acid to bring them back in line with the skin level.
  • Protruding scars can not be relined, they must be cut out, removed by milling or treated by other methods.
  • Large scars, which are distributed throughout the face, are treated by methods that cover the entire area. By cryopeeling (cold peeling), dermabrasio (skin abrasion) or chemical peels, all scars can be treated simultaneously.
  • Treatment with
    • A topical 0.1% tazarotene gel (applied once daily, by the patient) showed comparable efficacy and tolerability with microneedling in patients with atrophic acne scars (stages 2-4) six months after the start of treatment.
    • A combination of minimally invasive methods such as microneedling (dermaroller) and 15% trichloroacetic acid (TCA) led to particularly good results.
  • Acne scars can also be removed painlessly by laser therapy (CO2 laser, erbium Yag laser). Since the scar tissue is only in the upper layers of the skin, this is vaporized by the energy of the laser beams without scarring.