|
Figure 10.5 Acne scarring. (Source: Reprinted
from Weller et al., 2008.) |
One of the key aims of treatment is to prevent scarring. Should it become evident that scarring is occurring, the patient should be referred for more intensive treatment (National Institute for Clinical Excellence, 2001). Scarring is more likely to occur in patients who have nodules and/or cysts. However, tendency to scar is quite individual and each patient needs to be assessed individually as some people will begin to scar even with relatively mild acne (Figure 10.5).
There are some marks that are left on the face post-acne; these are lesions that are not strictly speaking scars. They are related to pigment changes. The final vestiges of the inflammatory process may appear as small red macules on the skin which will fade over the course of 6 months. Post-inflammatory pigmented lesions describe lesions where melanin has built up in the skin as a result of the inflammation. These may be in evidence for over a year and are often more noticeable in darker skin types.
True scarring can be one of two types. It can either be hypertrophic or atrophic. Hypertrophic scars (sometimes referred to as keloid scars) occur where there is excessive tissue giving the scars a raised up appearance that may extend beyond the margins of the original lesion (Mitchell and Dudley, 2002). The overgrowth of tissue is caused by excessive collagen being laid down in that area. Afro- Caribbean skin seems to be more prone to keloid scarring than other racial groups. Atrophic scars refer to those where there is a loss of tissue, so the lesion appears depressed from the surface of the skin. Different types of atrophic scars include:
- Ice-pick scars: Have a well-defined irregular edge and steep sides usually occurring on the cheeks.
- Atrophic macular scars: These are flatter on the skin surface and the skin may appear thin and somewhat wrinkled. Although they are generally small on the face, they can be larger on the body; with time, they appear whitish in colour.
- Follicular macular atrophy: These scars are so called because they tend to occur around hair follicles on the chest and back following on from severe acne. The elastin fibres in the skin are damaged so that rather than lying smooth and flat they bunch up and cause small lumps to appear in the skin looking rather like white heads. With time, as the elastin repairs, these lesions tend to flatten out (Mitchell and Dudley, 2002).
