Acne scars result from two types of tissue response to the inflammation of acne: (1) increased tissue formation, and (2) loss of tissue.
Increased Tissue Formation. The scars caused by increased tissue formation are called keloids or hypertrophic scars. The word hypertrophy means "enlargement" or "overgrowth." Both hypertrophic and keloid scars are associated with excessive amounts of the cell substance collagen. Overproduction of collagen is a response of skin cells to injury. The excess collagen becomes piled up in fibrous masses, resulting in a characteristic firm, smooth, usually irregularly-shaped scar. Keloids tend to "run in the family"—that is, there is a genetic predisposition to form keloids after tissue injury. African-Americans often have a predisposition to keloid formation. Some families also tend to form hypertrophic acne scars or thickened acne scars.
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Acne Scars Resulting From Loss of Tissues. Acne scars resulting from loss of tissue are more common than scars resulting from increased tissue formation. There are several types:Ice-pick acne scars get their name from their appearance. They may be superficial or deep, are usually small in diameter and have steep sides like an ice-pick wound. They may be hard or soft to the touch; the soft acne scars are usually more superficial and the hard scars deeper. The base of hard scars under the skin may be wider than the scar at the surface of the skin.Depressed fibrotic acne scars are usually large scars that have sharp margins and steep sides. They are similar in appearance to deep chicken pox scars.Superficial and deep soft acne scars are variable in size, and have sloping edges that merge with normal skin.
Follicular macular atrophy is more likely to occur on the chest or back of a person with acne. These are small, white, soft lesions, often barely raised above the surface of the skin—somewhat like whiteheads that didn’t fully develop. This condition is sometimes also called "perifollicular elastolysis." The lesions may persist for months to years.
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