Dermoscopy as a novel tool to examine and assess treatment response of acne scars: A pilot study in an Indian population

Objectives: Acne scars are common and have limited methods of evaluation. They occur due to decreased collagen (atrophic, rolling, icepick, boxcar, and linear) or increased collagen (hypertrophic and keloidal). There are very few studies concerning the evaluation and treatment methodology of acne scars by dermoscopy. The primary aim of the study was to observe the dermoscopic features of different types of acne scars. The secondary aim was to evaluate the role of dermoscopy in the assessment of response to treatment. Material and Methods: Thirty consenting patients with post-acne scars were enrolled for the study in a tertiary care dermatology center. Detailed history and clinical examination data were recorded followed by dermoscopic evaluation at presentation. Consequently, the standard treatment modality was chosen depending on the type of acne scars, and the procedure was done at monthly intervals. Dermoscopy was repeated at a frequency of 6 months. Concurrently, histopathological evaluation for collagen and elastin was performed in a case of deep atrophic scar. Result: Initial dermoscopy showed a poorly defined pseudo reticular network on the face and diffuse pigmentation interrupted by adnexal openings. Ice pick scars appeared as comedo-like openings along with an accentuated perifollicular pigmented network and vascular structures. Rolling scars showed valley-like areas with sloping edges and a marginal rim of pigmentation. Boxcar scars had characteristic cup-shaped depressions with a hyperpigmented rim and dilution of central pigmentation. On sequential dermoscopy following treatment, a decrease in perifollicular pigmentation, and a granular pigment network was seen. There was considerable curtailment of size and depth of acne scars. Further, an increase in the hair follicle density was observed following treatment. Scars of shorter duration showed better response compared to scars of longer duration. In histopathology, increased collagen deposition and early elastogenesis were observed. Conclusion: Treatment is more effective in cases of acne scars of shorter duration. Dermoscopy may be a valuable tool in the assessment of acne scars and their response to treatment.