Acne vulgaris is a huge problem, which affects 80 percent of people between ages 11 to 30 years. Many patients may experience some degree of scarring. This review focuses on atrophic scars, the most common type of acne scar. We briefly address the conditions that lead to scar formation and the initial evaluation of patients with acne scars. We then discuss an algorithmic approach to the treatment of acne scarring. It is based on the classification of scars. Lastly, we discuss the future treatment of spot scars and ongoing clinical trials.
Acne affects the face in most cases. Many patients experiencing some degree of scarring, the severity of which correlates to acne grade. The scars result from an altered wound healing response to cutaneous inflammation. In fact, we can find inflammatory cell infiltrating in 77 percent of atrophic scars. It contributes to variations in acne severity. In patients not prone to scarring, early lesions have a large, nonspecific immune response that subsides in resolving lesions. In contrast, in patients prone to scarring, early lesions are characterized by a smaller number of skin-homing in comparison to non-scarring patients. It is a response that becomes more active in resolving lesions.
Furthermore, production and degradation of collagen during the healing process leads to different types of spot scars. In 80 to 90 percent of cases, there is a net destruction of collagen in the dermis that results in atrophic scars. Less commonly, there is a net gain of collagen that results in scars.
These scars are classified according to the depth and size of destruction; however, the same person can be carrying different scar types. The appearance of spot signs may be accentuated by PIE in individuals with light skin. , it makes making differentiation difficult In addition to the variations in collagen which makes PIE treatment an important initial component of therapy.