Inflammatory acne causes scarring because severe inflammation damages the skin’s deeper layers, destroying collagen and preventing proper healing.
Acne starts when pores get clogged with oil, dead skin cells, and bacteria like Cutibacterium acnes. This clogging creates a perfect spot for bacteria to grow in a low-oxygen environment. The bacteria release irritating substances, such as free fatty acids from breaking down oils, which trigger the body’s immune response.[1][2]
Immune cells like neutrophils, macrophages, and lymphocytes rush to the area. They release chemicals including cytokines, histamine, prostaglandins, and reactive oxygen species. These fight the bacteria but also harm nearby skin tissue. The inflammation swells the area and weakens the follicle wall.[1][2][6]
In mild acne, the damage stays shallow and heals without marks. But in inflammatory acne, like nodules or cysts, the swelling goes deeper. The follicle often ruptures, spilling bacteria, oil, and debris into the dermis, the skin’s middle layer. This ramps up the inflammation even more.[2][3][6]
The deep inflammation attacks collagen and elastin, proteins that keep skin firm and smooth. Collagen breaks down faster than the body can replace it. Without enough new collagen, the skin heals with pits or depressions called atrophic scars.[3][5]
Picking or squeezing pimples makes it worse. This pushes debris deeper and causes extra trauma, leading to more inflammation and bigger scars.[5][6]
Even after the pimple fades, leftover inflammation can dilate blood vessels, causing red marks known as post-inflammatory erythema. In severe cases, the damage leads to lasting scars like ice pick, boxcar, or rolling types.[1][5]
Sources:
https://www.kins-clinic.com/blogs/post-inflammatory-erythema-from-acne-a-guide-to-causes-and-treatments
https://pmc.ncbi.nlm.nih.gov/articles/PMC12735603/
https://elosklinik.com/en/sivilce-tedavisi/sivilce-cukurlari-nasil-gecer/
https://www.london-dermatology-centre.co.uk/blog/acne-scar-recurrence-maintenance/
https://drhaach.com/treatments/acne-scars/
https://www.drmarylupo.com/advanced-skin-care-new-orleans/
