Mixed diagnoses – 10 cases (4 of 11)

True fibrous scars should be distinguished from active inflammatory or comedonal acne and from postinflammatory erythema, hypopigmentation or hyperpigmentation. There may be ice pick pitted scars, atrophic flat thin scars or hypertrophic/keloidal scars. This patient has ice pick and atrophic scars on her cheeks and chin.

Inflammatory acne with scarring should be treated aggressively, often requiring referral to a dermatologist for isotretinoin. Providing the acne is no longer active, the patient may wish to see a plastic surgeon or dermatologist for one or more of the following measures. For ice pick or atrophic scars: punch excision, subcision or grafting; soft tissue augmentation with collagen, hyaluronic acid or fat; dermabrasion; laser resurfacing. For hypertrophic scars: topical steroid creams or intralesional steroid injections; cryotherapy; silicone gel dressings; surgical revision. Dye lasers may fade the redness from scars.