Acne scar is caused by improper and delayed treatment of inflammatory acne.

Healing of inflamed acne lesions result in acne scars. The greater the inflammation, the deeper the scars. Skin repairs itself after any injury, including inflammation, by generating new collagen underneath. This deposition of new connective tissue causes acne scar . The main cause of acne scar is uncontrolled disease activity causing continuous inflammatory response within the dermis. The damaged skin repairs itself with scarring.

The Sequence Events Leading to  Acne and Acne Scar Formation

The sequence of  events leading to acne and acne scar formation is shown in the figure . The blockage of sebaceous duct due to altered keratin deposition in the walls leads to blockage of the hair follicle opening and retention of sebum. This is how comedones are formed. (Grade 1 or mild acne).

The injury to the dermis leads to an inflammatory response. An increase of the resident bacteria within the duct increases the inflammation resulting in papules (grade 2 acne) and pustules (grade 3 acne). Further retention of sebum and release of enzymes causes rupture of the sebaceous gland into the dermis.

This further adds to the inflammatory response and inflammatory cells accumulate deep in the dermis, leading to the nodule formation (grade 4 acne). Many such affected glands become confluent, resulting in the accumulation of pus, fluid and bacterial and glandular debris forming large acne cysts.

Acne Scar is caused by delayed or improper treatment of inflamed acne
Delayed or improper treatment of acne results in acne scar

When such inflamed lesions and cysts heal after rupture or absorption of fluid, with or without treatment, acne scars are formed. Severe, inflamed, cystic acne almost always leaves scars following healing, and in some people even superficially inflamed acne can result in scars. The size and pattern of acne scars will depend upon the size of the acne lesions as well as personal susceptibility to scar formation.

The  acne scars form two pattern of scars:

  1. Acne Scar with loss of tissue beneath the epidermis: These scars are depressed scars also known as atrophic scars and cause acne pits. These are caused by loss of support due to tissue damage in the dermis.
  2. Acne Scar with increased tissue regeneration in the dermis: These are similar to hypertrophic scars and Keloids. They are typically raised, firm, reddish, and, at times, painful and itchy scars.
Acne Scars: Related Reading

The information given in this article is for educational purpose only so that patients are aware of the options available for diagnosis and treatment of common skin, hair and nail diseases. No diagnosis should be made or treatment undertaken without first consulting your dermatologist. If you do so, the author will not be responsible for any consequences. The images provided are for illustration purpose only and should not be reproduced without the consent of the author.

About the Author of Skin Care Tips from Dermatologist: Dr Hanish Babu, MD
Dr Hanish Babu, MD, Dermatologist, Sharjah and Ajman, UAE
Dr Hanish Babu, MD

Dr Hanish Babu, MD is a dermatologist with more than 3 decades of experience in treating skin and sexually transmitted diseases in UAE and India. He has been practicing in UAE since last 22 years. He is a respected speaker during the Continuing Medical education Programmes for doctors, medical students and paramedical staff and is also a Stress Management Trainer. He organises group therapy sessions for patients with psoriasis, eczema and vitiligo.

He is available for consultation at Cosmolaser Medical Centre in Samnan, Sharjah (06 5678 200) from 9 am – 1 pm and at City Medical Centre, Al Bustan, Ajman (06-7 441 882) from 4.30 pm – 9.30 pm.

Visit his personal website for more details and for educational articles on Skin, hair, nail and sexually transmitted diseases. Click here to Book an Appointment with dermatologist Dr Hanish Babu, MD

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