Chicken Pox Scars

  • Best Results1-4 sessions
  • Treatment Recovery1-3 days
  • Procedure Time5-20 minutes
  • Skin SpecialistDavin Lim, nurses
  • Duration of ResultsVariable
  • AnaestheticNumbing
  • Back to Work1 days
  • Cost$-$$$

Chicken Pox Scars

Though much rarer than two decades ago, chickenpox is still a relatively common viral infection. It is more severe in adults compared to children in both systemic symptoms & skin scarring. Early & timely management of scars can, in most cases, lead to an excellent outcome without the need for surgical intervention. Old chicken pox scars can respond to limited subcision & dermal fillers.

FactsFacts On Treating Chicken Pox Scars

  • Chickenpox scars can be pigmented & or depressed
  • Pigmented scars can be treated with pigment correctors & pico lasers
  • Depressed scars can be improved with microneedling & fractional lasers
  • Home microneedling using 0.2 to 0.25 stamps can help mild scarring
  • Resistant atrophic scars can be treated with subcision & clinical microneedling
  • Fractional lasers can give good results for mild to moderate atrophic scars
  • Subcision can be combined with saline, PRP or dermal fillers
  • Dermal fillers provide predictable correction of chickenpox scars

How do I approach chickenpox scars?

A scar is not a scar. The optimal treatment will depend on many factors. Here are my thought processes for every scar patient-

  1. What is the level of scarring? Is it pigmented or atrophic or a combination of colour & depression. Is depression due to collagen loss, fibrosis or both?
  2. Where is the scar located? Chickenpox scars on the apex of the cheek, forehead, and bony nose areas are notoriously difficult to treat.
  3. What is the skin quality of the patient? What is the dermal thickness, what is the background skin like? How good is the patient with sun protection?
  4. What skin type is the patient? Darker skin patients are more prone to pigment changes.
  5. Has the patient got insight – realistic expectations? What other factors contribute to scarring? Background acne etc. I also profile the ability of a patient to generate collagen, smoking vs non-smokers, ethnicity, age & others. Body dysmorphic patients see scars that others do not.

How do I treat pigmentation changes from chickenpox?

Ideally simple home treatments (see below) can reduce skin PIH or postinflammatory hyperpigmentation. These include sunscreen & pigment correctors such as ascorbic acid & retinol.

If your pigment is stubborn, I use both nano & pico lasers to improve pigmentation. Pico lasers can markedly improve PIH within 2-5 months Treatments are painless & take 5-10 minutes to perform. I generally do space treatments 4- 6 weeks apart.

Book an appointment with my laser nurses for pico lasers. This will save you a consultation fee with myself. Believe it or not, post-inflammatory skin colour changes from acne & chickenpox are really basic treatments at Cutis.

What simple skin care ingredients can help fade chickenpox scars?

A good proportion of post-inflammatory hyperpigmentation can be faded with DIY topical skin care, so the chance of this working is about 60 to 70%. You are more likely to gain better results if you treat & prevent pigmentation early. 

Start off with sunscreen. Apply 2 ml twice a day. If you are not good with sun protection, all else will fail.

Add a good formulation of L-ascorbic acid (10-20%) in the morning, before sunscreen. In the evening use retinol serum 0.1%. From there slowly add pigment correctors that contain the following ingredients: azelaic acid, vitamin C, kojic acid, liquorice root, arbutin, glycolic, lactic, citric acids, botanicals including bearberry. For more on pigmentation inhibitors go to The Formulated. 

If you have long standing pigment, pico lasers give the best results. 2-4 sessions are usually recommended over 2-4 months.

What simple DIY steps can you take to treat chickenpox scars?

Early treatment is the key. Treat scarring with two goals in mind, firstly to decrease pigment (Post inflammatory hyperpigmentation) & secondly to reduce contour changes.

Ways to reduce pigment include-

  • Sunscreen twice a day, regardless of sun exposure.
  • Retinol & vitamin C can reduce pigmentation production.
  • Hydroquinone, arbutin, liquorice extract are potent pigment inhibitors.
  • Vitamin E can be useful.

Ways to reduce atrophy (depressed scars) 

  • Retinol increase collagen production
  • Microneedling DIY at home with a roller or derma stamping tool. Use a 0.2 to 0.25 mm roller or stamper. Do not use longer needles. Perform this weekly. See the section on DIY acne scar treatments as it is similar to the chickenpox protocol

See the section on injectables for a more detailed explanation.

Davin’s Viewpoint on Treating Chicken Pox Scars

In my era, the majority of people would have chickenpox at school. The upside of this infection early in life is that severity & scarring is much less compared to adult chickenpox. I do think the vaccine is a good thing, only if you can remember to get your booster shot. Even then, it is 95% effective.

If you do catch chickenpox early, you can mitigate scarring (as lesion counts are lower). Early valacyclovir, acyclovir or famciclovir is warranted. IVIG in special cases.

If you have early scars, timely intervention is highly effective. This can reduce pigmentation or PIH, as well as reduce atrophic scars. For pigment, the use of ascorbic acid, botanical pigment correctors, HQ & retinol is first line. For severe cases I use tranexamic acid orally in the absence of contraindications. Pico lasers are great because they address both pigmentation and mildly atrophic scars.

For intermediate cases of atrophic chickenpox scars a combination of intradermal saline & small spot lasers such as thulium, CO2 or even LP 1064 Nd Yag genesis mode can give an excellent outcome. Microneedling is another option, however lasers provide better remodelling.

For long standing chickenpox scars, I do prefer HA dermal fillers, sometimes with lasers or at home microneedling. Pox scars are much harder to treat compared to acne scars as there is more dense fibrosis with the former. I understand that patients want a permanent solution, rather than a temporary one (fillers). In most cases, even though the filler dissolves in 1-3 years, the presence of HA stimulates fibroblasts to produce collagen.

Other options include the use of dermal graft & stem cell nano-fat. I occasionally perform these procedures for patient’s that insist on natural products (very rarely requested). Fibroblast & adipose stem cell transfer are much less predictable than sticking in some filler. A dermal graft involves harvesting donor tissue from the back of your ear, processing the constituents (dermal harvest kits or dermal smashing), then reimplantation underneath the scar. ASC involves harvesting nanofat. The costs for grafts & stems really add up, namely ranging from $4900 to $8900 per procedure. Fillers are only a fraction of the price & offer more predictable results.

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