Atrophic scars are not as uncommon as they sound. In fact, research indicates that scarring is a common occurrence in acne patients, with an estimated 95% of acne patients experiencing it at some point or the other (1).
As you can imagine, scarring can lead to significant psychological effects such as reduced self-confidence, low self-esteem, social anxiety, and so on. This is why treating atrophic scarring early on is critical.
In this helpful guide, we will outline everything you need to know about effectively treating atrophic scars and reducing their physical appearance. First things first, let us understand what we mean by atrophic scars.
In This Article
What Are Atrophic Scars? What Does An Atrophic Scar Look Like?
Atrophic scars resemble a sunken area on the skin and often looking pitted (1). These scars occur when you lose skin tissue. Typically, your body can regenerate the lost skin tissue, but in the case of atrophic scars, it is unable to do so. Hence, you are left with a depression on the skin.
Atrophic scars may be caused due to the following factors (2):
- Inflammatory factors such as acne, chickenpox, cyst, etc. that cause collagen destruction
- Underlying infection
- Physical trauma such as injury, burns, surgery, etc.
- Genetic disorders such as Ehlers-Danlos syndrome
Moving on, let us look at the different types of atrophic acne scars in detail.
Different Types of Atrophic Acne Scars
When it comes to atrophic scars, the ice pick-type represents 60%–70% of total scars, the boxcar scars 20%–30%, and rolling scars 15%–25% (3).
Remember that getting rid of atrophic scars depends on the type you have:
1. Boxcar Scars
These scars, typically round to oval in shape, have a steep, defined border and are typically flat at the bottom. There are two ways to get rid of this scar type:
- Subcision Method: This method involves popping the scarred skin back up with a needle. This will ensure that the area is no longer sunken. However, you could experience bruising for a week.
- Ablative Lasers: This treatment type works by inducing holes in the scar tissue to boost collagen formation. Note that this treatment may hurt, and you might experience redness as well as crusting for up to ten days.
2. Ice Pick Scars
Anecdotal evidence suggests that you can get this type of scar removed with a single stitch. However, note that this procedure will leave a flatter scar in turn. You can also inject the scar with a filler to fill the depression. But, the filler will only last for about 6-12 months.
3. Rolling Scars
This scar is broad and crater-like, with rolling edges, and is usually wider than 4 to 5 mm (3). Laser treatment is used to treat it, especially if the scarring is severe.
Before you go for a specific treatment, you must identify the scar type and follow the best practices. Keep reading.
Atrophic Scar Treatment At Home
For effective atrophic scar treatment, follow these strategies and start treatment on the right foot:
Step 1: Identify The Atrophic Scars Correctly
As mentioned earlier, atrophic scars create pits and have a sunken appearance. Make sure to consult your dermatologist and figure out what kind of scars you have.
Once your doctor has examined the type, extent, and severity of your acne scarring, they will provide you with a suitable treatment plan to stimulate the skin and initiate the healing process.
Step 2: Invest In The Right Skin Care Products
Ask your dermatologist what kind of products you should use in your daily skin care routine. If you have atrophic scars, it is important that you use gentle cleansing agents to get rid of bacteria, excess dirt, and oil from your face. The idea is to keep your face clean and free from irritation due to harsh products.
In addition to this, here are some other practical tips you can follow:
- Always choose a moisturizer that is suitable for sensitive skin and free of any artificial dyes or fragrances. Gently massage the moisturizer into the affected area to prevent dry skin.
- Avoid soaps that irritate or dry out your skin.
- While taking a shower, pat your skin to cleanse it instead of aggressively scrubbing it.
Step 3: Go For A Silicone-Based Gel
While there is no research claiming the efficacy of topical treatments on atrophic scars, you can use silicone-based gel products to prevent them. These products are especially suitable for use on chickenpox to prevent abnormal scarring. Make sure to consult your dermatologist first.
At the end of the day, treating atrophic scars early on can improve the outcome and lower the intensity of any scarring that occurs subsequently. In the final section, we will look at some effective atrophic treatment options that you can go for.
How Do Dermatologists Treat Atrophic Scars?
The choice of atrophic scar treatment will primarily depend on your scar type. So, speak to your doctor about the recommended treatment options available. Treatments include:
1. Chemical Peels
According to research, chemical peels can help reverse skin aging and treat acne scars (3). In this process, a chemical – typically glycolic acid, pyruvic acid, or salicylic acid – is applied to the affected area and then removed. While removing the chemical, the outer layer of your skin also gets removed.
It is particularly useful in treating isolated box scars (as opposed to ice pick and rolling scars), which demonstrate 50-90% improvement (3).
You may experience irritation as a side effect after a chemical peel. Also, ice pick and rolling scars do not disappear completely. These scars require multiple chemical peel treatments combined with topical retinoids and alpha hydroxy acids.
2. Dermabrasion Procedures
There are two types of dermabrasion procedures that can be used to treat atrophic scars:
It is a less aggressive, more superficial type of dermabrasion. In this technique, the outer layer of the skin is removed to accelerate the natural process of exfoliation. If you have mild atrophic acne scars, this is the right treatment option for you.
Here is how this process works:
- A hand-held device blows aluminum oxide or salt crystals onto your skin. This helps to polish the surface of the skin.
- A vacuum tube is used to remove the crystals, along with the damaged skin cells, from your skin’s surface.
- Thus, the outer-most layer of your skin is removed, which often results in new skin growth.
This is a more invasive type of treatment that is used if your skin has deep pits due to scarring. This method involves the use of anesthesia as your skin requires freezing.
Here is how this treatment works:
- The patient is given anesthesia so that the skin can be frozen.
- The surgeon uses an instrument to remove the top layer of your skin, which causes the skin underneath to heal and create a smoother appearance.
Both the treatment types effectively treat scars and produce significant improvements in skin appearance (3).
3. Laser Therapy
There are two types of laser therapy treatments that your doctor may recommend:
In this type of laser treatment, the skin tissue is not removed. However, it helps stimulate new collagen formation and causes tightening of the skin, resulting in the atrophic scar being raised to the surface. Some of the most common non-ablative lasers that are used include NdYAG and Diode lasers.
Non-ablative laser treatment does not require a lot of post-operative care, making it a more popular treatment option for treating acne scars. It also results in fewer side effects, according to anecdotal evidence.
Ablative lasers remove the damaged scar tissue through melting, evaporation, or vaporization. Typically, a carbon dioxide laser or an Erbium YAG laser are used for the treatment of acne scars. These assist in tightening the collagen fibers beneath the affected area.
Ablative lasers can have adverse side effects such as bacterial, herpetic, or fungal infections. They may also result in some long-term problems such as hyperpigmentation, scarring, etc.
4. Soft Tissue Filler
This treatment type is useful for treating rolling atrophic acne scars. Here is a run-through of how the process works:
- Fillers (made of collagen) are used to level or raise the indented scars or pits to match the normal layer of your skin.
- The fillers are injected under the scar and provide instant results.
- With time, the soft tissue fillers improve skin volume and decrease the appearance of the scars.
5. Skin Needling
- The facial skin is disinfected, and a topical anesthetic is applied, which is left on for 60 minutes.
- The doctor uses a sterile roller comprised of a series of fine, sharp needles to puncture the affected area (about 1.5 to 2 mm into the skin). The needles move in a variety of directions, including backward and forward.
- The skin bleeds for a short time but soon stops. It develops multiple microbruises, thus boosting collagen and elastin fiber production.
Results start to show after about 6 weeks, but the full effect can take at least 3 months to occur.
Treating atrophic scars is not just important for good skin health – their presence can dampen a person’s self-esteem and make them feel self-conscious. Luckily, there is a way to make these scars go away and bring your confidence back.
Remember that choosing the right treatment for acne scarring can make all the difference.
Hence, you need to consult your dermatologist to understand the benefits and drawbacks of each treatment before you choose one.
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- Atrophic Acne Scarring
- Evaluating evidence for atrophic scarring treatment modalities
- Acne Scars: Pathogenesis Classification and Treatment