Acne Scarring
The inflammatory lesions caused by acne such as papules, pustules, nodules, and cysts can result in two types of changes to the skin—temporary pigment changes and true scarring. These lesions are common and can be just as must a source of psychologically
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Acne Scarring Neal Bhatia, Consuelo Veronica David, Salar Hazany, and Aman Samrao
34.1
Introduction
The inflammatory lesions caused by acne such as papules, pustules, nodules, and cysts can result in two types of changes to the skin—temporary pigment changes and true scarring. These lesions are common and can be just as must a source of psychologically distress to patients as active acne lesions. While pigment changes are temporary and resolve on their own over months to years, true scars are permanent. The appearance of true scars may be improved with various modalities including intralesional cortisone injections and laser therapies. Pigmentary alteration will be covered in another chapter, and in the following we will review true scars.
34.2
Background
True scars result from permanent changes to the epidermis, dermis, and subcutaneous tissue. Following the initial injury, tissue undergoes three stages of wound healing: inflammation, granulation, and tissue remodeling [1]. During tissue remodeling, keratinocytes and fibroblasts produce enzymes that dictate the proportion of matrix metalloproteinases (MMPs) to MMP inhibitors. Exuberance of the wound healing response, as well as a predominance of either MMPs or MMP inhibitors, determines how a scar will heal [1]. Acne scars are classified as atrophic or hypertrophic, and a summary of their clinical appearances is summarized (Table 34.1). Although research supports a genetic predisposition for the development of keloids, such a predisposition has not been suggested for atrophic scars.
N. Bhatia, M.D. (*) • C.V. David, M.D. • S. Hazany, M.D. • A. Samrao, M.D. Division of Dermatology, Harbor-UCLA Medical Center, 1000 W. Carson Street, Box 259, Torrence, CA 90502, USA e-mail: [email protected] J.A. Zeichner (ed.), Acneiform Eruptions in Dermatology: A Differential Diagnosis, DOI 10.1007/978-1-4614-8344-1_34, © Springer Science+Business Media New York 2014
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238 Table 34.1 Morphologies of acne scars Morphology Atrophic Ice pick
Description
Boxcar (shallow)
0.5 mm, flat-bottomed scar with sharply demarcated vertical walls
Rolling
4–5 mm with sloped borders
Sinus tract
Contiguous connections in the dermis and/or subcutaneous tissue. Sometimes epithelialized
Hypertrophic Hypertrophic
Keloid
Shape
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