Sunday, 05 April 2020 18:14

The Physiology of Acne Scarring

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Perhaps one of the most perplexing anomalies impacting the skin is the development and management of acne scars. To the aesthetic professional, they represent a challenge in devising the most appropriate pathway for treatment, as the final outcome of wound healing is variable and often unpredictable. One factor that remains constant is that the development of scars, no matter their source of injury, represents a complex configuration of events leading to their final stage of healing. The most common types of scars encountered in the aesthetic setting are those that are connected with or are a direct result of acne lesions. According to the American Academy of Dermatology Association, acne vulgaris affects up to 50 million Americans annually with many experiencing some degree of scarring.1 Although there have been numerous theories presented regarding the development of acne scars, and several approaches for treatment, a concise understanding as to acne scarring and repair in all skin types and ethnicities is not fully understood. The socioeconomic impact of acne scarring is globally observed for its influence on self-esteem and potential disfigurement and requires a multi-faceted approach in its management.



The pathogenesis of acne is generally attributed to the alteration of the quality of sebum lipids, androgen activity, proliferation of propionibacterium acnes (P. acnes), follicular hyperkeratinization, and the increased production of sebum and free fatty acids. Lipids that are produced by sebaceous glands signal transduction and are involved in several biological pathways. Lipids also play a role in both pro- and anti-inflammatory reactions, and hormonal influences by way of androgens contribute to the size of the sebaceous gland and sebum secretion. In cell histology and cultures, androgens are tasked with lipogenic activity as keratinocytes and sebocytes may be activated by the p.acnes bacteria. The activation of tissue necrosis factor, along with the production of various inflammatory cytokines, follicular rupture, nerve and immunoinflammatory cells, and abscesses all contribute to the wound healing cascade. It has been realized that the inflammatory reaction at the pilosebaceous gland was stronger and had a longer duration in individuals with scars than those without. Additionally, the inflammatory reaction was slower in those with scars versus individuals who did not develop scars. These individuals showed a strong relationship between the severity and duration of inflammation and the development of scarring. This factor suggests that addressing inflammation at the early signs of acne may be the best approach to assist in the reduction and prevention of acne scarring.2


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Erin Madigan Fleck


Dr. Erin Madigan-Fleck is an educational icon known for her 35 plus years of experience and expertise in dermatological skin sciences, integrative aesthetics, and wellness. She is licensed in Georgia as a master cosmetologist, aesthetician, and aesthetic instructor. She is also a certified dermatology technician, lecturer, author, and national educator for the skin care industry. She holds national certification with the NCEA, Oncology Esthetics International, and as a natural health practitioner with Certified Natural Health Professionals. She received her naturopathic doctoral degree from the University of Science, Arts, and Technology College of Medicine and is a member of the American Society For Nutrition, International Association for Applied Corneotherapy, and the Society of Dermatological Skin Care Specialists. Dr. Madigan-Fleck is the CEO and owner of Naturophoria, established in 2000.

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