Hypopigmented Scars At A Glance
- Best Results5- 40 sessions
- Treatment Recovery4-6 days
- Procedure Time30 min
- Skin SpecialistDermatologist, nurse
- Duration of ResultsLife
- Back to Work2-3 days
- Cost$ Partial Medicare rebate in most cases
White scars or hypopigmented scars are one of the most difficult types of scarring to correct. This is because pigment cells have been destroyed. The most common cause is physical destruction due to picking. Re-pigmentation is achieved when other pigment cells migrate to the white patches. It can take up to 6 months to see results.
FactsFacts on Treating Hypopigmented Scars
- White scars are due to loss of pigment cells called melanocytes
- The most frequent cause is picking acne
- The second most common cause is prior use of amphetamines/ ice
- Once destroyed, pigment cells need to repopulate in order to re-pigment
- Improving the contrast in skin color is the way forward
- Sun damage can be faded with fractional lasers
- Creams with ablative CO2 or microneedling can stimulate pigment production
- 3-5 sessions are required over 4-6 months
- In some cases I use narrowband phototherapy to stimulate pigment production
What causes Hypopigmented Scars?
White scars are due to the loss of both melanin (skin pigment) and melanocytes or pigment-producing cells located in the upper layers of skin. The most common cause is skin picking as it gouges out the pigment cells.
Skin picking can be due to habit, a condition known as acne excoriate. Another cause is picking due to ice or methamphetamine. White scars can also occur with shingles & rarely with chicken pox. Regardless of the cause, treatment is very difficult.
What skin care can I use to treat white scars?
Sunscreen can reduce the contrast changes of scars. This reduces pigment in normal skin, making the contrast less noticeable.
Retinol & ascorbic acid can help build collagen & reduce unwanted pigmentation. Vitamin E & ferulic acid can act as antioxidants, reducing UV induced collagen loss.
What makeup is best?
There are many makeup brands that can provide camouflage. Dermablend & Second Skin comes to mind. You will need to discuss colour matching with a makeup artist.
What procedures can help with white scars?
I inform all patients that this is one of the most challenging forms of acne scarring to treat. If there are contour changes, namely atrophy or divots, subcision, lasers, RFM & fillers are appropriate.
For actual colour loss, my aim is to firstly increase the amount of melanin within the white areas, & secondly decrease the perceived pigment in normal areas. I usually combine fractional thulium 1927 lasers, with fractional CO2 lasers. I also use both Bimatoprost & occasionally Tacrolimus ointment to aid in pigment formation & melanocyte regeneration. Even with this technology the chances of repigmentation remain low (less than 30%).
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Can ReCell help?
I have nearly a decade of experience with ReCell, in my hands the success rate is just over 20%, ReCell essentially is melanocyte harvesting.
My harvest site is on the upper arm or thigh. I prepare the donor site with either fractional erbium laser or ablative laser resurfacing. The harvest is then broken down by enzymes & the melanocyte concentrated down. The dressing goes on for just over 5 days. Patients are required to undertake phototherapy for up to 6 months following ReCell.
Can microneedling help?
Yes, this is one of my other options. I normally microneedle every 2-3 weeks, followed by both tacrolimus & Lumigan daily as well as phototherapy 3 to 4 times a week.
Phototherapy is essential as it stimulates pigment production. This is performed at Cutis Medical. It involves coming to our center at least twice a week. This procedure is bulk billed with no added costs for patients.
Can psoralen therapy help?
If you live away from a phototherapy center you can get your dermatologist to supervise psoralen topically. I do not supervise this treatment as it is beyond my scope of interest. Discuss topical PUVA with a medical dermatologist trained in this procedure. Daylight psoralen therapy is widely used in Asia & the Middle East.
Topical psoralen can be combined with microneedling & other topicals. Be guided by your dermatologist.
Is cosmetic tattooing a feasible option?
This is technically difficult. The best person to talk to is someone who is experienced in cosmetic tattoos or the feather touch technique. A perfect match is required.
Contrast changes are not infrequent, especially in the summer months with tanning.
What do I need to consider before seeking treatments?
White acne scars are one of the hardest types of scarring to treat. The chances of repigmentation relies on your skin’s ability to generate melanin or pigment. All procedures & skin care topicals do is to stimulate pigment. Some people have viable pigment cells left, others do not.
Things to consider before embarking on a re-pigmentation include-
- Understanding the chances of success & failure.
- Understanding that it may take up to 6 months to assess if treatments are working or not.
- Understanding that in some cases phototherapy may be required. This means 2-3 sessions per week. These sessions are bulk billed with no cost to the Medicare card holders, however it does require dedication for at least 20 weeks.
Davin’s Viewpoint- Treating white scars
Probably the most unpredictable aspect of acne scar revision is to predict who can generate enough re-pigmentation & who can not. I do think that fading of normal skin (tanned or sun damage) together with increasing pigmentation in white areas is the way to go.
My go to treatments include fractional 1927 thulium to normal skin, coupled with fractional CO2 laser to white areas. In some cases I add topicals as described, in other cases I add narrowband phototherapy.
Regardless of treatments, it does take 20 weeks or more to see if your melanocytes are still viable– these cells provide pigment.
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