Atrophic scar is an unfortunate permanent effect of acne outbreaks, accidents, and chicken pox, which may cause significant emotional and psychological distress. This article will give you a rundown of everything you need to know about atrophic scarring including causes and treatment options available.
Atrophic Scarring – What Is an Atrophic Scar?
An atrophic scar is a collection of fibrous tissue that takes the form of a sunken recess in the skin which gives the skin a pitted appearance. Atrophic scarring is often associated with various dermal conditions including acne, chicken pox and MRSA infection. Surgical procedures and injury to the skin can as cause it.
As with any form of scar, all atrophic acne scars are permanent, but there are numerous ways available to improve their appearance and make them less noticeable.
Atrophic Acne Scars
Atrophic acne scars are the most common type of scars resulting from acne breakouts even though some patients may develop keloid and hypertrophic scars. They normally result when collagen fibers and subcutaneous fat are destroyed as a result of inflammation due to a breakout of cystic acne. They are normally characterized by a sunken and pitted appearance.
In an article published in The Journal of Clinical and Aesthetic Dermatology, Douglas Fife, MD, a dermatologist at the Surgical Dermatology & Laser Center in Las Vegas, Nevada, points out that acne scars affect 1 to 11 percent of the general population and as much as 95 percent of patients with acne vulgaris.
Although scar formation is a helpful natural process that helps the skin to heal after an injury, abnormal or altered production of collagen often leads to poor restoration of the cutaneous surface and irregularities in the texture of the skin which we then perceive as atrophic acne scars.
How your skin scars after a bout of acne depends on factors such as the severity and depth of the acne outbreak, genetic propensity to scarring, age and ethnicity. Exposing the scars to excessive sunlight can also worsen their appearance.
Atrophic acne scars ranges from rolling scars (those that seem to disappear when the skin is stretched) to ice pick scars and boxcar scars.
Atrophic Scar Tissue Vs Hypertrophic Scar Tissue
As we have already mentioned, atrophic scars is associated with sunken recesses in the skin which make the skin have a pitted look similar to that of a golf ball.
This is usually the result of insufficient production of collagen as an infection heals or the loss of the underlying structures that support the skin such as muscles and fatty tissue. Acne is on of the most common underlying factors for atrophic scarring.
Hypertrophic scar tissue is on the other hand normally raised to a level above the surrounding skin. It is usually the result of collagen buildup in the site of wounding.
Atrophic Scar Treatment – Atrophic Scar Removal
The goal of atrophic scar treatment is usually to build up the tissue on the site of scar so that the level of the skin is raised to that of the surrounding healthy skin. The appropriate atrophic scar treatment technique depends on the actual type of scar out of ice pick scars, boxcar scars and rolling scars.
Here are a number of atrophic scar removal options that you may want to discuss with your GP or a dermatologist:
Dermabrasion: If you have a case of mild atrophic scarring, then you might be a candidate of dermabrasion. This involves using special ablative devices to scrape away the top layer of the skin at the scarring site and stimulate the growth of new, healthy cells.
Subcision: Subcision is often used to release the bands of collagen that are tugging the skin downwards.
Filler injection: Atrophic scars – especially rolling scars – often benefit from an injection with dermal fillers such as hyaluronic acid (Restylane, Perlane or Juvéderm) which helps to fill them out and raise them to the same level as the rest of the skin.
Filler injection is normally associated with a very short downtime period, but on the downside, it gives temporary results which typically last about a year.
Laser therapy: Atrophic scars usually benefit from laser treatment. This involves using high energy laser pulses to vaporize the scar tissue in order to stimulate the growth of new healthy skin.
Fractionated carbon dioxide (CO2) laser and Erbium-Yttrium-Aluminum-Garnet (Er:YAG) laser are two common options for resurfacing of atrophic scars. Several sessions of laser treatment are however usually required for optimum results.
Chemical peels: Minor atrophic scars usually respond well to chemical peels. This involves using acidic products (applied as in chemical peels) to remove the top layer of the skin and the dead skin cells on it and expose new, healthy skin cells. This also stimulates the production of collagen in the skin.
You will however have to undergo a downtime of about one week during which the skin will be peeling off. You will also be bruised and swollen for several hours after the treatment.
Surgical scar revision: There are numerous surgical options available to improve atrophic scarring. Punch techniques such as punch excision and punch lift are the most commonly used. Medical microneedling can also be used to improve atrophic scars.
Punch excision involves cutting the scar out and stitching the skin together using fine sutures that are then removed after a few days to avoid the formation of stitch tracks which can be counterproductive. Punch lift on the other hand involves cutting the scar and lifting it up to the surface of the skin whereby it is then stitched into position.
Atrophic Scar Cream
If adolescent acne left you with atrophic scars as a blatant proof of those pesky moments, you can benefit from one of the many scar creams available on the market today. Some of the more popular creams out there are Kelo-cote and Scarguard. Mederma may be worth your time even though whether Mederma works or not remains a controversial topic.