Atrophic scarring occurs when the skin is unable to properly regenerate tissue following an injury or inflammation. This type of scar forms as a depression below the surrounding skin surface. It results from a deficiency in the body’s ability to produce sufficient connective tissue during wound healing, leading to a noticeable indentation. Atrophic scars are characterized by a loss of volume rather than an excess of tissue.
Distinctive Features
Atrophic scars are characterized by their sunken or pitted appearance, creating a depression in the skin. These indentations result from insufficient tissue regeneration during the healing process. Their texture can feel uneven compared to the surrounding skin, often appearing unstretchable.
There are three main types of atrophic scars, each with a unique shape. Ice pick scars are narrow, deep, and V-shaped, resembling small punctures extending into the dermis. Boxcar scars present as broader, rectangular depressions with sharp, defined edges. Rolling scars are wide and shallow, featuring rounded, sloping edges that give the skin a wave-like or undulating appearance.
How Atrophic Scars Develop
Atrophic scars primarily form due to a disturbed healing process where the body fails to produce enough collagen. Collagen is a protein that provides structure and support to the skin. Its insufficient production or damage during healing leads to a loss of underlying tissue, causing the scar to sink below the skin’s surface.
Common causes for the development of atrophic scars include severe acne, particularly cystic acne, which damages the skin’s deeper layers. Chickenpox is another frequent cause, often leaving behind characteristic pitted marks. Additionally, certain injuries, surgical procedures, or the removal of moles can disrupt the skin’s regeneration process, contributing to the formation of these depressed scars. Reduced fibroblast activity, which are cells responsible for collagen production, also plays a role in their formation.
Atrophic Scars Versus Other Scar Types
Atrophic scars are distinct from other common scar types, particularly hypertrophic scars and keloids, due to their depressed nature. They result from a loss of tissue and insufficient collagen production, causing them to appear sunken or pitted below the skin’s surface. This contrasts with raised scars like hypertrophic scars and keloids.
Hypertrophic scars develop when the body produces an excess of collagen during healing, leading to a thick, raised appearance that remains within the boundaries of the original wound. Keloids also involve an overgrowth of scar tissue due to excessive collagen, but they extend beyond the original wound margins, forming larger, often irregularly shaped growths.
Management and Treatment Options
A range of approaches exists for managing and treating atrophic scars, aiming to improve their appearance by stimulating collagen production or filling the depressions. Topical treatments, such as those containing retinoids, can be used to help improve skin texture over time. Chemical peels involve applying a solution to exfoliate the skin, promoting new skin growth and potentially reducing scar depth.
Microneedling is a procedure where tiny needles create controlled micro-injuries in the skin, which stimulates the body’s natural healing response and encourages new collagen formation in the scarred areas. Laser therapy, including ablative and non-ablative lasers, can resurface the skin by removing damaged layers or stimulating collagen remodeling beneath the surface. Dermal fillers, often composed of hyaluronic acid, can be injected directly into atrophic depressions to temporarily raise the scar and achieve a smoother skin contour. For some deep scars, a technique called subcision involves inserting a needle under the skin to break up fibrous bands that pull the scar downward, allowing the skin to rise. Consulting with a skincare professional is important to determine the most suitable and effective treatment plan.