There are many reports of tretinoin & retinol based topicals trailed in patients with atrophic scarring. The results to date have been disappointing. Having said that, it is worth a try. Retinoids are cost effective, with little if any side effects, providing you exert common sense in the application.

In theory, based upon the histological findings of epidermal atrophy, a thin & atrophic papillary dermis & a lack of inflammatory cells, lasers may be a sensible option to stimulate collagen production.

With so many unknown variables, my usual practice is to deliver multiple, low energy settings of fractional lasers over a timeline of 18 months. Conservative CO2 is best, using logic & science. In some cases, a test spot is required, meaning a small area is treated, then followed up in 6 months to ascertain whether treatment is successful or not. Test spots are best conducted in a department or university setting.

I do believe over the next two decades we will have a better understanding of this mysterious condition. Working backwards from the histology, treatment options for AMVC may include-

Dermal grafting & stems: Either manual grafting or the dermis or novel treatments such as Rigenera / Regenera. True results, as per studies, are not seen until the 24-month mark.

Modified epidermal micrografting: I am currently working on this as of 2022. It may work, it may not. Higher risk procedure than novel techniques & fractional CO2. Ideally this should be conducted in a university or hospital setting, see below.

Off label dermal fillers: I am currently trialling PLLA & Ca OH fillers, delivered via the epidermis. The atrophy is too shallow for traditional HA dermal fillers. I have not got a set protocol yet, as of 2022.

There are conditions that can look like AMVC both clinically & histopathological. Therefore patients require a review by a team of medical dermatologists before a label of AMCV is given. Ideally this should be done at a hospital or university setting. Conditions include-

• Atrophic pathology secondary to inflammatory dermatoses including morphea, atrophoderma of Moulin, subclinical DLE, keratosis pilaris atrophicans & acne
• Missed post infection pathology: Zoster, HSV atrophy, elastolysis secondary to infection including folliculitis & resultant elastolysis
• Missed accidental traumatic scars: from childhood
• Psychological issues including dermatitis artefact

Disclaimer: The above conditions need to be excluded by a medical dermatologist. AMCV is a diagnosis of exclusion. My job now is an operator, & not a diagnostic dermatologist.

Ideally a biopsy is conducted on the lesion to confirm or exclude this condition (exclusion is less likely, as if you have true atrophy, it will be confirmed on pathology. The question is – if atrophy is due to some other pathology).

True AMVC has the following histological features, epidermal & papillary atrophy with the absence of cellular inflammation, namely a quiescent immune system without lichenoid changes. I also believe that true cases of atrophia maculosa will have an absence of dermal melanin (points towards a lichenoid cause).

Blood work up will show a normal ESR, CRP, negative ANA, ENA & other antibodies. A clinical examination may show associated incidental acne, &/or atrophic lesions elsewhere.

Note: If you are really concerned about your AMCV, you should see a department of dermatology near you. Ideally the test above will be useful. Collection of biopsy specimens will aid further research. I do not take biopsies; however I will be more than happy to confirm or exclude the diagnosis if contacted by your consultant specialist. I do not get involved in patient management, just a second opinion arranged by your dermatologist.

Lots of theories, nothing proven. To date papers have suggested that this can be related to hepatic problems, genetic conditions & acne. Other papers have postulated that this is a form of burnt out subclinical / sub-inflammatory morphea, classifying this as atrophoderma of Moulin. The bottom line is that we really do not understand this condition well.

If we do not understand a problem, then there is no universal solution. Hence why I feel this entity should be treated in a university or departmental setting.

The debate arises whether AMVC is burnt out morphea or atrophoderma of Moulin. This is based on histological & clinical findings. I have seen cases of Moulin, & these look very different from true AMVC of the face. Moulin cases are Blaschkoid on the trunk. They are hyperpigmented (at least the ones I have seen).

AMVC is polymorphic, I acknowledge that some patterns are linear following modified Blaschko lines, however many cases do not follow this pattern. I have seen punctate, circular, linear, crescentic & geographical patterns of AMVC.

Lots, but like others I do not have a reliable solution, nor do I have a true understanding of the aetiology. Unlike acne scars whereby in many cases there is a clear & defined treatment pathway, AMCV has a dearth of unknown factors. 

I do believe in this entity, though I do think that in some of the published cases scars resemble chicken pox, trauma (crescent shape, possibly nails), dermatitis artefacta (for real!) or unusual geographic forms of acne scars (box car like linear scars).

Ideally Atrophia Maculosa Varioliformis Cutis should be managed in a hospital or university setting. My reasons for this include-

Collection of Data: much easier in a department of dermatology, as enrolment of patients is easier. Additionally ancillary help from registrars are provided. This saves time & resources.

Access to a group of dermatologists is a big advantage. Many sets of eyes are useful to confirm/exclude the diagnosis. Any input from colleagues are useful.

Costs: this is important for patients. IMO all experimental options should be subsidised. This can not be done in a private practice setting. It places pressure on patients & treating dermatologists, not ideal. Treatments should be conservative.

Follow ups: Again resources & costs can be better allocated in a university or hospital setting. This way data can be shared to other departments worldwide.

It depends on the situation. If this condition falls under the objective classification of severe (as defined by the Goodman Baron classification), I do treat it. If objective & subjective viewpoints are not met, I do not treat it. This means if AMCV cannot be readily seen at conversational distances in normal lighting, I do not take the case on. You are best seen at a tertiary level.

In many cases, autoimmune conditions need to be excluded. A general dermatologist can assist.

There are many patients who have AMCV & subsequent BDD or body dysmorphic syndrome. Unlike most cases of inflammatory dermatosis, the majority of AMCV is subtle, hence the name macular (flat or relatively flat), the exception to this rule are cribriform & feline variants of atrophia maculosa. These two variants warrant treatment due to the extent & depth. 

If you have AMCV & the average person at conversational distances cannot see the problem, then objective scar assessment falls under the minor category. This does not mean that you can’t have your condition treated, it means that I am not the right dermatologist for you. My work is primarily focused on severe objective grades of scarring. See my comments below.

This entity spoils it for everyone involved in research. As the name suggests, it is an artifact, or caused by the patient. Yes, this really slows down R & D & takes up much needed human resources that can be devoted into real clinical outcomes. This subgroup of patients exist (believe it or not), they create trauma & scar patterns to gain attention for others; either online or in real life.

This condition is best treated in a public hospital by a senior dermatologist.

Dermatitis Artefacta patients frequently troll websites & support groups including acne.org, realself & FB Groups.

In Australia, if you have objectively severe AMVC I will be more than happy to take up your case. Additionally, if you have associated Grade 4B acne scars & minor AMCV, again I would be super happy to treat you.

If you reside overseas, you should see a dermatologist near you. Ideally your cases should be viewed by a team of dermatologists to confirm or exclude other causes of atrophy including inflammatory & post inflammatory conditions. You are best served in a university or hospital setting.

Disclaimer: I do not treat body dysmorphic patients. If objective photography cannot capture your scars in normal lighting, you may have BDD. It is not that you cannot have treatments, it just means that I do not perform high risk procedures in this patient group.

Keyboard professors will have their own viewpoint on forums. Some may be sensible, others somewhat silly. My job is to provide safe advice, not the most aggressive. Any advice given must account for the lowest common denominator, or the blunt tool in the shed. If you want to ‘have a go’, try some dermastamping.

1. Clean area.
2. Use a dermastamper, it is far safer than a roller or pen. Stamp 0.25 to 0.3 mm.
3. Apply a retinoid after.
4. Do this every 3-4 weeks, for 12 months.
5. Do not try acupuncture needles or acids, your skin is atrophic to begin with.

In the future we will know more about this condition. AMCV was first reported in 1918, fast forward a century later & we still don’t know about this condition. I do believe that newer technologies to deliver stems/fibroblasts/keratinocytes to the affected area should yield better results in the next few decades. 

An efficient method of data collection is to have these patients filtered in a University or department setting in a hospital. This way data can be readily shared worldwide, further aiding research. This includes a collection of biopsies, as this acts as a library for future lesional genetic coding & mutation testing.