Acne Scars

Classification and Treatment, Second Edition

Antonell Tosti, Maria Pia De Padova, Gabriella Fabbrocini, Kenneth R. Beer, Antonell Tosti, Maria Pia De Padova, Gabriella Fabbrocini, Kenneth R. Beer

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781351717670
• Edition: 2
• Topic: Medicina
• Subtopic: Teoria, pratica e riferimenti medici

Visible scarring may be a daily reminder of disease long after active acne has subsided. Frequently, it is a cause of distress for the patient and a leading cause for visiting medical professionals. This updated and expanded edition of an acclaimed pioneering text will be invaluable for both general and cosmetic dermatologists, plastic surgeons, and primary care physicians with a specialist interest in the skin as an invaluable guide through the complexities of treatment.

1

Classification of Acne Scars: Clinical and Instrumental Evaluation

Giuseppe Micali, Francesco Lacarrubba, and Aurora Tedeschi

Key Features

•Several classifications of acne scars have been proposed but a consensus is still lacking.

•A standard method for evaluation of scar depth represents an unmet need and is essential for therapeutic and prognostic purposes.

•Non-invasive instrumental techniques such as high-frequency ultrasound and three-dimensional digital photography may help for a more accurate and reproducible evaluation and classification of acne scars.

Introduction

Scar is defined as “the fibrous tissue that replaces normal tissue destroyed by injury or disease” [1]. Causes of acne scar formation can be broadly categorized as the result of increased tissue formation or, more commonly, loss or damage of local tissue [2]. Clinical manifestations of acne scars and severity of scarring are generally related to the degree of inflammatory reaction, to tissue damage, and to time lapsed since the onset of tissue inflammation [3,4].

Clinical Classifications of Acne Scars

There have been several attempts to classify acne scars in order to standardize severity assessments and treatment modalities [3,4]. However, consensus concerning acne scar nomenclature and classification is still lacking, even among acne experts [3,5].

In 1987, Ellis and Mitchell proposed an acne scar classification system and first utilized the descriptive terms ice pick, crater, undulation, tunnel, shallow-type, and hypertrophic scars [6]. Langdon, in 1999, distinguished three types of acne scars: type 1—shallow scars that are small in diameter; type 2—ice pick scars; type 3—distensible scars [7]. Lately, in 2000, Goodman proposed that atrophic acne scars may be divided into superficial macular, deeper dermal, perifollicular scarring, and fat atrophy based on pathophysiologic features [8].

According to the grading system proposed by Jacob et al., acne scars may be clinically classified as atrophic or hypertrophic [9]. Atrophic scars are subclassified into three basic types depending on width, depth, and three-dimensional architecture:

•Ice pick scars: Narrow (diameter <2 mm), deep, sharply marginated, and depressed tracks that extend vertically to the deep dermis or subcutaneous tissue.

•Boxcar scars: Round to oval depressions with sharply demarcated vertical edges. They are wider at the surface than ice pick scars and do not taper to a point at the base. These scars may be shallow (0.1–0.5 mm) or deep (≥0.5 mm) and the diameter may vary from 1.5 to 4.0 mm.

•Rolling scars: Occur from dermal tethering of otherwise relatively normal-appearing skin and are usually wider than 4–5 mm in diameter. An abnormal fibrous anchoring of the dermis to the subcutis leads to superficia...