Tag Archives: acne scars

Acne Scar Causes

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  dr-hanishbabu.com 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

Acne 101: The Acne Basics


Acne 101 will discuss the acne basics in general. A basic knowledge of acne is important to learn how to effectively treat acne in its varied clinical presentations and avoid complications like acne scars.

The course of acne is punctuated with frequent flare-ups in the affected and hence acne is to be approached as a chronic disease which requires active treatment intervention and a maintenance program for optimal control of the inflammatory pimples. During the adolescent years acne can cause untold heartbreaks and psychosocial impacts, which makes it a disease to be handled with proper care and knowledge.

Is Acne a Disease or a Normal Physiological Problem of the Adolescence?

Acne is a disease of the pilo-sebaceous unit which includes the hair follicle and the associated sebaceous gland. It is not just a normal age related phenomenon, as hormone related pathological changes assisted by the bacteria propionibacterium acnes occur in acne and result in long lasting effects on the skin, like pigmentation and scars. The Global Alliance to Improve Outcomes in Acne in their report presented as a supplement to the May issue of Journal of American Academy of Dermatology advocates approaching acne as a chronic disease requiring initial aggressive therapy followed by maintenance therapy to avoid the complications and minimized the social and psychological fallouts of the acne.

When it is very mild and limited to a few numbers of comedones, acne can be considered physiological. The presence of inflamed papules, pustules or presence of nodules and acne cysts calls for active treatment of the acne.

How Common is Acne?

Acne is the commonest skin disease. It affects approximately 85% of young people. Previously thought to be a disease of the adolescents, acne is also common in adults from 20 to 35 years of age. The common acne is called acne vulgaris. There are many variants of acne like neonatal acne, drug induced acne, chloracne, acne excoriee, keloidal acne etc.

How Does Acne Occur?

Many factors play a role in the causation of acne, including a hereditary predisposition, effect of androgenic hormones and many other external and internal factors. After puberty, androgen hormones stimulate the sebaceous glands to increase their size and produce more sebum, an oily liquid intended to keep the skin smooth and supple. The sebum is a good growth media for certain bacteria, which in turn produces inflammation within the hair follicle and the surrounding dermal structures. Depending upon the severity of the inflammation, the types of acne also vary in different individuals and at different times in the same individual.

What is the Age Incidence of Acne?

Contrary to popular belief, acne can occur at any age, from neonates to old age. Mostly acne is seen in early puberty to early adulthood, i.e., the ages of 12 to 25 years. About 50% of teenage acne can continue to adulthood. Some people, especially females, tend to have an occasional flare ups into their 30s. At the age of 40, 1% of males and 5% of females still have active lesions of acne.

Does Acne Differ in Males and Females?

Males and females are affected equally in acne, though the severity of acne is more in males. Almost all boys and 90% of girls will have had an attack of acne during their teen age. Acne conglobata or nodulocystic acne is more common among males.

Moderate Acne: Type 3
Moderate Acne

What are the Common Areas of the Body Affected by Acne?

Acne can develop on any hair bearing area, though it is most common on face, as this is the area with the maximum density of sebaceous glands. In the face, the cheeks, nose, chin and forehead are mostly affected, in that order most of the time. Acne on face is most commonly known as the pimples or zits. Acne also occurs on the chest, shoulders, upper back, buttocks and thighs.

Is it True that Excess Dandruff is the Cause of Acne, especially on the Forehead?

Dandruff and acne has got some common features as their causes, like increased seborrhea, oily skin and the effect of the androgenic hormones. Hence both are complimentary; one is not cause of the other.

What are the Common Signs and Symptoms of Acne?

Whiteheads and blackheads are the earliest skin lesions in acne. Depending upon the severity acne is divided into different types of acne, the comedonal, papular, pustular and nodulocystic.

In presence of inflammation, in the pusutlar and nodulocyctic variety, the acne eruptions can be red, painful and hot and tender on touch.

The skin of acne sufferers is usually greasy and oily and most of them suffer from concomitant dandruff during the acne attack or later in their life.

Oiliness and sudden eruptions can sometimes cause an itchy feeling on the acne affected area.

Though the commonest skin disease affecting more than 85% of world’s population at least once in their life time, there are many misconceptions and myths regarding acne vulgaris.

Published by Dr Hanish Babu, MD on 23rd May, 2018

The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis

should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD