Prospective Study of Pathogenesis of Atrophic Acne Scars and Role of Macular Erythema

J Drugs Dermatol. 2017 Jun 1;16(6):566-572.


<p>BACKGROUND: There are few studies on the natural history of acne lesions including the antecedents of atrophic scars.</p> <p>STUDY DESIGN: Prospective study of relationship between primary (papules, pustules, comedones) and secondary lesions (atrophic scars, macular erythema, and hyperpigmentation) over 6 months. Subjects (n=32) had moderate facial acne including 10 or more atrophic acne scars and were their own control via randomized split-face design. Lesions were mapped 2x/week for 2 months and every 2 weeks thereafter until month 6 to track pathogenic progression.</p> <p>RESULTS: Clinical assessment showed acne scars continuously forming throughout the 6-month study period. While the majority (66.2%) of these scars did not resolve by study endpoint, the remainder were transient. The likelihood of a scar developing from a primary acne lesion was 5.7%, and almost all scars arose from erythematous macules or hyperpigmentation (83%) and some (16%) developed directly from papules and pustules. Duration of papules was a key factor in the risk of scarring. The majority (81.7%) of the scars remaining at 6 months were still present at 2-year follow-up.</p> <p>CONCLUSIONS: Atrophic acne scars continuously form, some resolve, and evolve primarily from inflammatory and post-inflammatory lesions. Clinicians should closely monitor patients with macular erythema for scarring.</p> <p><em>J Drugs Dermatol. 2017;16(6):566-572.</em></p>.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Acne Vulgaris / complications*
  • Acne Vulgaris / pathology*
  • Adolescent
  • Adult
  • Atrophy / pathology
  • Cicatrix / etiology*
  • Cicatrix / pathology*
  • Double-Blind Method
  • Erythema / complications*
  • Erythema / prevention & control*
  • Face / pathology
  • Female
  • Follow-Up Studies
  • Humans
  • Hyperpigmentation / pathology
  • Inflammation / pathology
  • Male
  • Prospective Studies
  • Skin / pathology
  • Treatment Outcome
  • Young Adult