Acne vulgaris natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Complications
Acne Scars
See Acne scarring.
Severe acne often leaves small scars where the skin gets a "volcanic" shape. Acne scars are difficult and expensive to treat, and it is unusual for the scars to be successfully removed completely.
Physical acne scars are often referred to as "Icepick" scars. This is because the scars tend to cause an indentation in the skin's surface. There are a range of treatments available.
Although quite rare, the medical condition Atrophia Maculosa Varioliformis Cutis results in "acne like" depressed scars on the face.
Ice pick scars - Deep pits, that are the most common and a classic sign of acne scarring.
Box car scars - Angular scars that usually occur on the temple and cheeks, and can be either superficial or deep, these are similar to chickenpox scars.
Rolling scars - Scars that give the skin a wave-like appearance.
Hypertrophic scars - Thickened, or keloid scars.
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Pigmentation
Pigmented scars is a slightly misleading term, suggesting a change in the skin's pigmentation, and that they are true scars. Neither is true. Pigmented scars are usually the result of nodular or cystic acne (the painful 'bumps' lying under the skin). They often leave behind an inflamed red mark. Often, the pigmentation scars can be avoided simply by avoiding aggravation of the nodule or cyst. When sufferers try to 'pop' cysts or nodules, pigmentation scarring becomes significantly worse, and may even bruise the affected area. Pigmentation scars nearly always fade with time taking between 3 months to two years to do so, although rarely can persist.
On the other hand, some people, particularly people with naturally tanned skin do develop brown hyperpigmentation scars which is caused by a local increased production of the pigment melanin. These too typically fade over time.
Prognosis
Acne usually goes away after the teenage years, but it may last into middle age. The condition often responds well to treatment after 6 - 8 weeks, but it may flare up from time to time. Scarring may occur if severe acne is not treated. Some people, especially teenagers, can become very depressed if acne is not treated.