Scar is the body’s natural way of healing and replacing lost and damaged skin. The damage of the skin can be due to infection, injury, surgery or inflammation that heals by replacing the normal skin with fibrous tissue or scar. Scar may form anywhere on the body. The appearance and composition of scar may differ, it can be pale, sunken, plumpy, itchy or coloured. Likewise, there are different types of scars. Most of them fade with time. Some of them can be reduced with dermatological treatment. As there are different types of scars, so there is a different approach to treat of a specific scar.
In this post, we would discuss about a common type of scar that is pale, flat or depressed type. Such a scar is called as an atrophic scar.
But before we start, we emphasise that treatment can only reduce appearance of scar and cannot totally erase it.
An atrophic scar is the most common type of scar as a result of body’s natural healing. Initially it is red and raised, in gradual course of healing it shrinks to become flat or depressed appearing as a pit on surface of skin. These may appear darker or lighter or paler than the surrounding normal skin. These scars are not painful but may be itchy for a few initial months. These scars are permanent, but can sometimes improve or minimise with time.
Mostly acne and skin viral infections like chickenpox heal leaving a depressed scar. Such scars may appear as sharp V shaped or shallow or deep U shaped pits on normal surrounding skin. Stretch marks are also a variety of Atrophic scars, these have been discussed in previous posts.
There is no way to completely eliminate a scar, it can only be minimised. There are different types of treatment available for specific scar types.
Scar removal creams
Many creams are available in market with such fancy and misleading names. The benefits derived from these creams is as unrealistic as is their names. The creams containing cocoa butter, wheat germ oil, lanolin, onion extract, vitamin E, centella asiatica leaf extract, aloe Vera and hyaluronic acid are being commonly used to minimise scar appearance. They have shown some benefits in few small scale trials, but clear cut benefits of them in reducing scars lacks in large scale comparative trials.
Chemical peels
Chemical peels are often used to minimise sun damaged, irregular pigmentation and superficial acne scars. In this procedure, a chemical solution of known strength is applied on skin. This causes controlled shedding of superficial layer of skin and promotes collagen remodelling. This process improves the appearance of superficial acne scars. This procedure has been discussed in previous posts.
TCA CROSS technique
In this procedure, trichloroacetic acid (50%-100%) is applied carefully in the base of a depressed acne scar. It causes inflammation, necrosis and subsequent collagen remodelling, thus elevating the scar.
Microdermabrasion
This is a superficial skin resurfacing procedure that utilises gentle mechanical abrasion to remove the outermost layers of skin. It may have some beneficial effect on improvement of superficial acne scars. This procedure has been discussed on previous posts.
Dermaroller or microneedleing
This is another technique that commonly used to improve acne scars. In this technique, a roller device with tiny microneedles is used to roll over scarred surface for 10-15 minutes. This causes softening of scars, realignment of existing collagen and stimulation of new collagen; thus overall improvement of scar. This procedure is discussed in detail in a previous post.
Laser resurfacing
In this procedure, specific lasers (Fractional CO2 laser) are used that project the laser beam which is fractionated or broken into small micro-beams over scarred area. This microbeams induce small zones of injury in upper skin layers. This induces collagen remodelling on scarred area, similar to that of dermaroller technique. The benefits obtained with this treatment are at par or may be better than dermaroller micronedling technique. But the treatment with lasers is much costlier than dermaroller.
Fillers
Sometimes a depressed scar can be elevated and improved by injecting synthetic collagen or hyaluronic acid filler (semipermanent or permanent type) underneath the base of depressed scar.
Punch grafting technique
This is used for treatment of pitted depressed type scar. In this procedure, punch of skin layers is taken out from healthy area of skin that is preferably not exposed (from gluteal or behind ear area). This is then placed on the pit of depressed scar and dressing is done. In a few days, the recipient scarred area accepts the skin graft from donor area. This elevates the pitted scar and improves its appearance.
Treatment of scars is real challenging. The partial benefits may be obtained from combination of these treatments. Superficial scars improve better than deeper scars. Most common modality to effectively reduce scars is dermaroller or laser resurfacing by fractional CO2 lasers. Results of fractional CO2 lasers is slightly better than dermaroller, but dermaroller is more cost effective compared to laser treatment.
In our setup, we commonly use chemical peels, microdermabrasion and dermaroller microneedling for treatment of acne scars.
What is microdermabrasion?
Microdermabrasion is a common cosmetic procedure that improves your skin texture and complexion. It reduces fine lines and wrinkles, giving you a youthful appearance. Microdermabrasion is a quick, painless and non-invasive treatment. It is a superficial skin resurfacing procedure. This means that it increases the rate at which dead skin gets removed, and starts the proliferation of new skin cells.
Dr Monika Misra
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