Often, pitted or sunken scars in the skin are the legacy of adolescent acne. These lesions are caused by incomplete healing at the site of infection. When the healing skin does not produce enough collagen and other fibrous tissues, the result is an atrophic scar. Dermatologists have an array of treatments available for this type of scar, as well as many others. With an atrophic scar, the goal is to build up the tissue in the former infection site so that it levels and matches with surrounding healthy skin.
An atrophic scar is one in which the healed surface of the skin is below the level of normal dermal tissue, creating a small pit. It is characterized by a soft, white appearance and is often a result of acne. The atrophic scar contrasts with a hypertrophic scar in which the healed tissue is built up above the level of the normal surrounding skin.
Atrophic scars form whenever the skin produces insufficient collagen, or connective tissue, to heal the site of an infection. The result is a pitted scar similar in structure to the surface of a golf ball. The goal of treatment is to stimulate the skin's natural healing process to replace collagen, elastin and other fibrous tissues, so the surface of the healed lesion is contiguous with the normal skin surrounding it.
Types of Treatment
The dermatologist has a number of procedures at hand for treating atrophic scars, including the following:
• Microdermabrasion: Patients with mild scarring are usually candidates for this treatment in which tiny particles in a vacuum tube gently scrape away the top layer of the scar and stimulate the growth of new cells.
• Laser therapy: Laser pulses enable the dermatologist to remodel the surface of scars by smoothing and sculpting them. Most commonly used are the carbon dioxide laser, the yellow light laser and the erbium:yttrium-aluminum-garnet (Er:YAG) laser.
• Soft tissue filler: In this procedure, bovine collagen, polymer implants, collagen-type fillers or the patient's own fat taken from another site is injected in tiny quantities below the surface of the skin to raise pitted scars.
Dermabrasion, Peels and Surgery
In some cases where scarring is more extensive, the dermatologist may employ dermabrasion in which the surface of the skin is frozen while the patient is anesthetized. The surgeon uses an instrument to remove the topmost layer of skin; when the skin heals, it has a smoother and healthier appearance. Chemical peels are also used to destroy the top layer of damaged skin, so that regenerated skin grows and removes or conceals the atrophic scarring. In other cases, an atrophic scar is surgically removed and replaced with a piece of healthy skin from another part of the patient's body.
Lasers vs. Dermabrasion
In a multicenter study based at the University of Miami School of Medicine, Keyvan Nouri, M.D., and other researchers found that carbon dioxide and Er:YAG laser treatment is preferable to dermabrasion for atrophic scars; both offer the surgeon better control than dermabrasion. Laser resurfacing of moderate atrophic scars with a carbon dioxide laser improves those scars by 50 to 80 percent, according to the study.
With either type of laser treatment, the patient can expect to have reddened, inflamed skin for 48 hours afterward. Also, there is some risk of infection as well as temporary darkening, or hyperpigmentation, in the treated areas.
The Er:YAG laser treatment is best used for sculpting the edges of individual atrophic scars, while the carbon dioxide laser produces more collagen replacement as well as tightening of the scar surface, according to study results.
Whatever the cause and extent of your scarring, modern treatments offer a greatly improved appearance, which can boost self-confidence. Ask your dermatologist about the pluses and minuses of the various treatment options to find the one that is best suited for you.