The Incidence and Psychosocial Impact of Post-Acne Scarring
Acne vulgaris is a disease of the pilosebaceous unit that affects 40 to 50 million individuals in the United States.1 Approximately 95% to 100% of adolescent boys and 83% to 85% of adolescent girls are affected by acne, which persists into adulthood in up to 20% of cases.2 Postadolescent acne appears to occur more frequently in women than men.3 Although acne is the most frequent primary diagnosis at visits to dermatologists,4 it is often dismissed by patients and physicians alike as a natural part of growing up that has few real consequences.5 However, facial scarring occurs to some degree in 90% to 95% of patients, with both sexes affected equally.6-8 The appearance of atrophic scars can worsen with age, especially if there is concomitant photoaging.9
Post-acne scarring is associated with significant psychosocial distress, comparable to that in patients with active acne lesions.10 Patients with acne scars report low self-esteem, social anxiety, and withdrawal.11 The degree of psychosocial distress is not correlated with the severity, size, or location of the scarring, but rather the patient’s subjective perception of their scars.12,13 A recent study found patient self-assessment of severity—but not clinician assessment—was statistically associated with psychological morbidity such as depression and anxiety.13 Clinicians should consider the psychosocial sequelae of skin disease not only in those with objectively more severe disease, but also in patients across the severity spectrum.13
In the past, post-acne scarring therapies were limited by significant morbidity and marginal improvement.14 While outcomes, safety, and choices have greatly expanded and improved, outcomes remain unpredictable and usually require multiple procedures over time.15 Patient satisfaction with treatments is low; current procedures provide moderate improvement but are generally associated with suboptimal long-term improvements.15-19 Further confounding the process is the lack of consensus regarding efficacy scales or treatment guidelines,18 although a good qualitative scale has been developed.20 Consequently, it is important that clinicians establish realistic expectations with patients prior to treatment selection to facilitate good patient outcomes.
Acne Scar Types and Their Pathophysiology
There appears to be a genetic predisposition to poorly resolving inflammation that underlies post-acne scarring.14 The degree.