Acne vulgaris: Complications Acne vulgaris
Cutaneous inflammation caused by acne lesions
True Scars
Authors: Stephen Williams Reviewers: Mehul Gupta, Lauren Lee, Yan Yu*, Laurie Parsons* * MD at time of publication
Elevated Acne Scars
↑ collagen exceeds collagen degradation
Prostaglandins (PGE2), leukotrienes (LTC4, LTD4), and thromboxane A2 are released in response to inflammation
Atrophic Acne Scars
Collagen degradation and disordered deposition during healing
Formation of round-
rectangular depressions with defined edges
Box Car Scar
True scars with textural change, very slow autoresolution over time
The pigmentary changes and true scar formation resulting from acne may be more psychologically distressing than the original acne lesions
Healing processes favoring deposition of Type 1 & Type 3 collagen
Proliferation beyond the borders of original acne lesion
Keloid Formation
Healing processes favoring deposition of Type 4 collagen
Growth remains within the margins of acne lesion
Hypertrophic Scar Formation
Dermal inflammation: Due to disruption of basal cell layer, melanin released and trapped by macrophages in the dermis.
Epidermal inflammation: ↑ melanin production and transfer of melanin to keratinocytes
Microvascular dilatation and ↑presence of erythrocytes
Erythematous macules appear where acne was present
Post- inflammatory Erythema (PIE). More common in Fitzpatrick Skin Types I-III
Formation of V- shaped tracts with sharp margins
Ice Pick Scar
Formation of a
shallow edged depression layer anchored to dermal layer and subcutis
Rolling Scar
Pigmented
macules or patches appear where acne was present
Post-inflammatory Hyperpigmentation (PIH). More common in
Fitzpatrick Skin Types III-VI
No textural change, slow
autoresolution over time
True scars with textural change, do not resolve over time
Psychosocial Concerns (Depression, Anxiety, Social Isolation)
Legend:
Pathophysiology
Mechanism
Sign/Symptom/Lab Finding
Complications
Published October 19, 2021 on www.thecalgaryguide.com