Cicatrizes de Acne: Patogênese, Classificação e Tratamento Baseado em Evidências

Acne scars result from inflammatory destruction of dermal collagen/elastin during healing.

Pathogenesis

Inflammatory infiltrate → matrix metalloproteinases (MMPs) degrade collagen.
Repair: fibrosis (excess collagen) → hypertrophic/keloid; or insufficient collagen → atrophic.

Atrophic (80–90%): Ice pick (narrow, deep), Boxcar (wide, sharp edges), Rolling (undulating, tethered).
Hypertrophic/Keloid: Raised, firm; keloid extends beyond wound margin.
Post-inflammatory hyperpigmentation (PIH): Not true scar; melanin excess.

Scar Type	First-Line	Second-Line
Ice pick	TCA CROSS (high-concentration trichloroacetic acid)	Punch excision + grafting
Boxcar	Fractional CO₂/Er:YAG laser	Subcision + filler
Rolling	Subcision (releases fibrous bands)	Microneedling RF, filler
Hypertrophic	Intralesional triamcinolone	Pulsed dye laser, silicone gel
Keloid	Triamcinolone + 5-FU	Radiation post-excision, cryotherapy

Early, effective acne treatment (retinoids, benzoyl peroxide, antibiotics, isotretinoin) reduces inflammatory burden → fewer scars.

Combination modalities yield best improvement; complete eradication rare.