October 05, 2020

Atrophic scars are some of the most common types of scars. They appear dented and can form in any part of the body from the face, hands, and legs. This article discusses atrophic scars causes, types, and treatments.

What are Atrophic Scars?

An atrophic scar is a complication that develops when skin tissue is lost to an infection, and the healing occurs below the outer layer of the skin. It results from the skin tissue failing to regenerate correctly, leaving scars that are not balanced. These scars usually have an indented appearance. 

Types of Atrophic Scars

There are three main types of atrophic scars. They include:

1. Ice-pick Scars

This type of scars derives its name from the appearance - they look like holes that have been punctured using a sharp object that resembles an ice pick. They make up about 60 to 70 percent of atrophic scarring. 

These scars are usually deep but not as wide as the rest. Their width is not more than 2 millimeters. The scar’s opening is wider than the base forming something close to a ‘‘V’’ shape. This makes them easily noticeable to the naked eye. 

Ice-pick scars are more challenging to treat than the other scars, and even after treatment, they may not clear completely.

2. Boxcar Scars

These scars have flat box-like bottoms and comprise about 20 to 30 percent of atrophic scars. They have an oval or round shape with defined vertical edges. They are wider at the surface compared to icepick scars but not as wide as rolling scars. 

Instead of the tapering “V” shape, they form something that resembles a “U’’ shape. They can be shallow or deep, depending on the degree of severity. 

The shallow ones are easier to get rid of, but the deeper ones are harder to treat. They are mostly found in areas where the skin is relatively thick such as the jaw and the lower cheeks.

3. Rolling Scars

Rolling scars are named so because they give the skin a rolling or wavy, uneven appearance. This rolling appearance comes about because the fibrous bands of tissue developed between the skin and the subcutaneous tissue pull the epidermis from within and bind it to the skin’s deeper structures. 

The shape resembles that of the letter ‘‘M’’. Rolling scars have broader bases and, unlike the other two, have sloping edges instead of distinct edges. They are also found where the skin is thicker like on the cheeks.

It is possible to find the three types of atrophic scars in the same patient, and it can be quite hard to tell the scars apart.


Causes of Atrophic Scars

The most common cause of atrophic scars is severe acne. The scars are left behind after the healing of acne lesions. The severity of the scars will depend on how well your skin heals. If your skin tends to scar easily, then you will most likely develop atrophic scars. 

The development of atrophic scars is also dependent on inflammation. Mild inflammation of acne lesions heals quickly, and the scars are easy to get rid of. 

But if the inflammation is prolonged, a scar will likely form on that area of the skin. This is why you should treat acne inflammation as quickly as possible to reduce the risk of severe atrophic scarring.

Atrophic scarring can also occur when the acne lesions are picked or squeezed. Therefore, you should be careful not to pick at or squeeze your acne to prevent damaging your skin. Even if you are doing this to remove pus, you should do so cautiously and only when necessary.

Lifestyle habits such as smoking also increase the risk of developing atrophic scars from acne. 


  • Chickenpox

Besides acne, chickenpox can also cause atrophic scars. Chickenpox is a common viral disease that is caused by the Varicella zoster virus. 

Although the infection rates are low, many children and even adults who have been infected still have atrophic scars from the disease. Some studies show that chickenpox leads to facial atrophic scars in about 7 to 18 percent of cases.  

The scars may also be caused by scratching of the chickenpox lesions. This damages the skin, thus leading to scarring. 

  • Mole removal

An atrophic scar may also occur when you get a depression of the skin where a mole has been removed. The severity of the scar depends on the size of the mole and the technique used to remove it. 

Also, failure to take good care of the wound after mole removal can make the scarring worse. It is crucial to have the mole removed by a professional in a sterilized environment to reduce the risk of atrophic scars. 


Treatment of Atrophic Scars

Treatment varies depending on the type of scars you have. Other factors that determine the treatment method include the skin type, the location, and depth of the scars. 

Before you pursue any treatment line, it is essential to seek professional guidance from your doctor or dermatologist as they can guide you on the best treatment options for a speedy recovery.

There are two options for atrophic scars removal. Depending on the severity of your scars, you can either choose over-the-counter remedies or seek professional treatment. 

Natural or Over-the-counter Remedies

It is important to note that natural or over-the-counter treatment methods may only improve the scars’ appearance. But, they may not be very effective if you want to get rid of the scars completely. 

Here are a few atrophic scars home remedies. 

1. Rosehip Oil

The essential oils from rosehip contain antioxidant and phytochemical properties. Applying rosehip oil to fresh scars twice a day for at least three months may improve atrophic scars’ appearance.

2. Cocoa Butter

It contains antioxidants that help to keep the skin moisturized. Cocoa butter can improve the appearance of scars if used for an extended period. 

3. Lemon Juice

Lemon juice works just like Aloe vera and is suitable for lightening scarred skin. Applying lemon juice onto atrophic scars at least two times a day reduces the atrophic scars’ severity. 

4. Exfoliation

Exfoliation works by removing old and dead skin cells on scars to make room for younger and better-looking skin. Exfoliation can be done mechanically or using chemicals. 

Mechanical exfoliation involves scrubbing the scar using scrubbing tools and brushes. Chemical exfoliation, on the other hand, consists of the use of lotions and oils that remove the top layer of skin, leaving the scarred area looking better. 

The above remedies should be used regularly and for an extended period to see any noticeable results. As we said earlier, they may not be very effective, so the best thing would be to pursue professional atrophic scars treatment.


Professional Treatments For Atrophic Scars

1. Chemical Peels

Chemical peeling involves applying chemicals to the skin’s scarred area to remove the damaged layer and improve the appearance. This is effective even in the treatment of deep atrophic scars such as ice-pick scars. 

Depending on your scars’ severity, you may opt for a light peel, a medium peel, or a deep peel. A light or medium peel can be done quickly at your dermatologist's office. 

You may have to do several light or medium peels over some time for noticeable results. By contrast, deep peels are more complex and severe, and you may take longer to heal but are very effective

2. Dermabrasion and Microdermabrasion

These are mechanical facial resurfacing techniques that involve the removal of the top layer of the skin. Microdermabrasion is superficial, and it removes only the outer layer of the skin and accelerates the natural process of exfoliation. 

On the other hand, dermabrasion completely removes the top layer of the skin and penetrates deeper into the skin tissue inducing skin restructuring. Both methods are very effective against scars, and the final result is a significantly improved appearance.

3. Laser Treatment

This treatment method is ideal for people with boxcar scars or rolling scars. It helps to improve the appearance of old scars and can even restore sunken chickenpox scars. 

Laser treatment can even lighten the scarred area. Different types of laser resurfacing will be used depending on the severity of scarring. The process is not complicated and can even be done in less than 2 hours.

4. Excision

You should only consider scar excisions when all the other scar treatment techniques have failed. Excision involves the surgical removal of scar tissue using a scalpel or a punch tool. It is perfect for deep, sunken scars such as ice-pick scars.

5. Scar Removal Creams

Atrophic scar treatment creams contain ingredients that are effective in managing scars.  For example, creams with retinol and glycolic acid stimulate collagen production, which helps to repair damaged skin and improve the appearance of atrophic scarring.


Parting Shot

In conclusion, you should understand that the treatment of atrophic scars is complex and takes a lot of time. There is no guarantee that your scars will go away completely. 

Also, each method comes with inherent risks. In some cases, the treatment may leave you with new scarring or may not eliminate the initial scar. Also, some of the treatments may need to be repeated to provide the best results.