Atrophic Acne Scar Risk and Reflectance Confocal Microscopy Predictive Features

Background: Acne scars are considered the result of complex pathophysiologic mechanisms and can have a profound impact on an individual's quality of life, often leading to diminished self-esteem, depression, and anxiety. Early detection and targeted treatment are crucial. To the best of our knowledge, the correlation between RCM features and acne scar risk has never been assessed. Aims: Our study aims to explore if any specific morphological RCM feature is associated with acne scar formation and progression. Methods: Patients were subdivided into groups to compare average values or frequencies of each analyzed variable. To assess the significance of clinical changes between T0 and T1, Student's t-test and Chi-squared test were performed. Odds ratios were calculated to estimate the relative risk of developing acne scars when a specific parameter was detected. Results: Our study demonstrates that, in a population predominantly constituted by IGA = 2 grade patients, clinical examination alone does not effectively identify the risk of novel acne scarring. The presence of RCM inflammatory infiltrate was significantly associated with an increased risk of scarring; OR 4.23 (CI: 2.05–8.71). Conclusions: Identifying specific microscopic parameters, such as vascular changes and inflammatory infiltrate in the skin of acne patients, could be helpful to predict development of new acne scars, allowing for optimized therapies at early disease stages.