Acne scarring is a common and expected result of moderate to severe acne vulgaris. Given the clinical variety of acne scars and the plethora of treatment options available, management of cutaneous scarring from acne can be challenging and confusing. This article discusses the pathophysiology of acne and acne scarring to better understand its biologic and structural nature. A simple, yet practical classification schema is presented, allowing caregivers to better organize their assessment of acne scarring and develop useful management strategies from this model. This article highlights the various useful laser options that are available for the treatment of acne scarring.
Acne pathophysiology
Acne vulgaris, popularly known as acne, is an inflammatory dermatosis of the pilosebaceous unit (ie, the hair follicle and its associated sebaceous gland) and is characterized by the presence of comedones (whiteheads and blackheads), inflammatory papules and pustules, cysts, and nodules. Acne is believed to be caused by the interplay of 4 separate pathophysiologic factors: (1) keratin dysadhesion along the follicular epithelium resulting in the formation of a keratin plug or microcomedone, (2) increased sebum production by the sebaceous gland, (3) bacterial overgrowth, and (4) inflammation ( Fig. 1 ). Trigger factors known to contribute to acne formation include exogenous factors, such as occlusive agents (skincare products, makeup, and so forth), and endogenous factors, such as androgen hormones and specific medications (eg, antiseizure drugs).
