Types of Acne Scars

Acne scars may be divided into different types according to the morphology, depth, extend and tissue response to inflammation.

Hence, Classification of Acne Scar Types may be done in different ways:

  1. Depending upon depth
    • Superficial Acne Scar
    • Deep Acne Scar
  2. Depending upon tissue response
    • Atrophic Acne Scar
    • Hypertrophic Acne Scar
  3. Depending on the extent of involvement
    • Localised Acne Scar
    • Scattered Acne Scar
    • Extensive, Disfiguring Acne Scar
  4. Depending on the site of involvement
    • Facial Acne Scar
    • Body Acne Scar
  5. Depending upon the severity and duration of acne scar
    • Temporary Acne Scar: Very superficial scars, which fill out and gradually disappear over time.
    • Permanent Acne Scar
  6. Wrong Category!
    • Acne Pigmentation, acne blemishes or acne spots: Whether brown, red, or later black, pigmentary or color changes caused by acne should not be classified as acne scars, as actual scarring does not occur in such cases. The deposition of iron pigment and stimulation of melanin pigment as a secondary response to dermal inflammation are the reasons for acne pigmentation or acne blemishes or acne spots. These are temporary color changes and are completely reversible. As expected, the acne blemish treatment differs from the acne scar treatment in a number of ways. 

Whether acne scarring is deep or superficial, extensive or scattered, the esthetic result can be less than desirable and even disturbing. By causing loss of elasticity and smoothness of the skin, the acne scars contribute to an aged look to the skin.

Acne scars form mainly two Acne Scar Types

  1. Acne Scar types 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 types 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.

Atrophic Acne Scar Types:

Atrophic Acne Scarring: Pitted and Ice Pick Acne Scars
Pitted (depressed) and Ice-pick Acne Scars
  • Ice-pick acne scars , as the name indicates, are similar to ice pick wounds: steep sides and a broader base than the surface of the scar. They may either be deep or superficial, soft or hard. The size is usually small, from 1 mm to 2 mm in diameter.
  • Depressed fibrotic acne scars are similar to large and deep scars caused by chickenpox. Superficial and deep scars, soft or firm, they have a sloping edge, which gradually merges with the skin surface.
  • Atrophic Macular Acne Scars: Seen usually in body acne, the chest and back. These are small, flat, soft, papery white and thin scars . Sometimes the color may be bluish, violacious or brownish depending upon the skin texture, color and underlying blood vessels which become visible through the thinned epidermis. The atrophic macule type of acne scars gradually fade over time and become less noticeable after a few months or years.

Hypertrophic Acne Scar Types

Atrophic and hypertrophic Acne Scars in the back
 Atrophic and hypertrophic Acne Scars in the back
  • The scars caused by increased tissue formation are called hypertrophic acne scar types and Keloids. Overproduction of collagen in response to tissue injury caused by acne inflammation in the dermis is the cause. Excess deposition results in raised, thickened, and, at times, itchy and painful bumps.
Deep Acne Scars
Deep Acne Scars
  • While hypertrophic scars are self limiting and can occur in anybody, the keloidal acne scars tend to continue to grow. Keloidal tendency is hereditary and is thought to be due a deficient enzyme which is supposed to stop the collagen synthesis when optimum tissue repair is achieved. The result is uncontrolled collagen generation leading to thick, raised, fibrous and tender scars.

The Hypertrophic and Keloid acne scar types in turn can be of three types:

  • Soft Scars: The connective tissue is dispersed loosely with elastin fibres interspersed within collagen fibres and the scars are soft to the touch
  • Firm Scars : Loose but a little dense packing of collagen fibres with sparse elastin fibres. Firm to touch
  • Hard Scars: Densely packed ‘glassy’ collagen fibres with little or no elastin fibres. Hard, rocky feeling to touch. Toughest acne scar to treat.

As can be surmised, the treatment of atrophic and hypertrophic varieties of acne scars differ from each other.

Related Articles on Acne Scars:

Disclaimer

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

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