• Acne scars are polymorphic and have different shapes, sizes, depth and surface texture.
• Multiple types usually co-exist in the same patient.
• There are several scales to grade acne scars in use, but none are ideal.
• It is also important to assess the psychosocial impact of acne scars when judging severity.
Acne is one of the most common chronic inflammatory disorders in adolescence and young adults that is increasingly persisting in older adults. It affects the pilosebaceous apparatus, characterized by variable morphology and severity with a tendency to scarring. Acne
scars are the product of end-stage inflammatory lesions. Mild and
adequately treated acne can
resolve without any residual scars, while chronic, severe or
inappropriately treated acne, results in scarring. Postacne scarring is
one of the most common causes of facial scarring that can lead to great psychosocial distress.
Atrophic scars are due to loss of collagen, whereas increase in collagen tissue causes hypertrophic scars. Atrophic scars are three times more common as compared to hypertrophic scars.
Each type of scar has its own unique characteristics and features.
Because of these differences, it is important to know the type of scar to choose the optimal treatment (Figs 2.1A to G). Multiple types usually co-exist in the same patient and thus there is no single ideal procedure for all types of acne scars.
The incidence of various types of scars has not been well studied. In one of the early studies it was found that ice pick scars were the most common, representing 60 to 70 percent of total scars, the boxcar scars represented 20 to 30 percent, and rolling scars 15 to 25 percent among the different types of acne scars.
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