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Minnie90

White scars on chest and shoulder - Follicular macular atrophy. Preparing for home treatment

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I have some white scars left after acne of my chest and shoulder - follicular macular atrophy . I have been reading and searching online and learned that this is because of loss of pigment . 

I just ordered a cream called Melgain , and next i will buy a UV lamp ( Any recommendations? :)

The plan is to use the cream with a short dermaroller (because the skin pigment is very close to the skin surface)  and then use the UV lamp . 
This seem to work for the skin pigmentation disorder Vitiligo . I thought i give it a try for the white scars that i have. 

Has anyone here had succsess with treating white scars like this ? Or any other method ?

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I've been in contact with the man who started that topic, but he rejected that it ever helped him. 

I tried the uv lamp, but i didnt notice any improvements.  This is how it looks today.  Does anyone have suggestions what i could try to make it more even? IMG_20170917_161904.jpg

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If your referring to the raised nature of the spots laser, tca peels, or electrosurgery can be used on this, your issue is more textural. Please see a derm with experience on body scars and not someone who has not done something with this. Also please checkout the faq - top post of the acne scar sub, there is a section called skin and find "hypo" pigmentation, it's been updated recently. That is only dealing with the white. In your case you may be fine with just resurfacing and getting things more even for your spots. That would be the easiest route, still a bit white but blended with the skin. 

I wouldn't call this classic hypopigmentation as I see some pigment, so resurfacing may be all that is necessary of course your doctor will see it in person and have a better handle of the skins condition. I originally didn't see a picture so thanks for sharing. 

@Obi wan ...thoughts?


 

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Here's my personal experience with this, Minnie90. 

This is not hyperpigmentation nor the regular kind of scarring9 you get from a cut or deep acne lesion. 

This is called follicular macular atrophy or peri-focular elastocis. It is associated with another yet similar skin disorder called anetoderma or another skin condition called dermal elastocis. 

This happens because there is loss of elasticity around the hair follicule resulting in a raised white bump. Sometimes you can see hairs coming out of these spots because the hair follicule is not damaged. A lot of them have a tiny hole in the center which is essentially a undamaged skin pore but no hair comes out. The follicule is therefore not repaired. 

There's not much information about this condition online. Some sites say they disappear over time as the body tries to repair the elastic fibers while other sites say they last forever. I am sure more information is to be found in many medical books or scientific papers published in journals. 

I happen to have this condition. I probably have 1000 + of these white bumps covering my shoulders, upper arms, shoulder blades, upper back, buttocks, jawline, thighs and my right side of my lower back. A lot of them are not white but yellow in color. They are not always evident. Angled lighting makes them extremely noticeable however. 

I must say I am in a constant battle with body acne for 20 years. The acne has significantly subsidied over the years. Unfortunately, this is what is left behind from all those years of cysts and boils. 

I always thought of them as hypertrophic scarring which is the end result of a deep healed cut. I have many of these from accidents which are raised, white and within the site of the original injury. I tend to scar in this manner after a deep cut or scrape. It seems however these little white bumps have nothing to do with hypertrophic scarring. 

Furthermore, some sites say they are aborted whiteheads. Seems to me that the skin gets stretched to the point that it damages it's elastic properties and the skin remains raised. In that sense, we can think of them as mini-stretchmarks. Some sites say that over time the skin regains it's elastic abilities and the spots vanish. I do not know whether these spots are actually scar tissue or not. I also believe that the dermis in itself is not damaged because hair and pores can be seen in the centers of the spots. 

My personal experience with these is that I had them since my early teenage years. It could be my imagination or simply a lack of memory but over the years, it seems to me that some have vanished. Some have flattened but remain white or yellowish while other spots have not changed. I also have many recent ones because I kept getting body acne for the last 20 years. Keep in mind also that I can only look at my back through mirrors. With the redness and pimples gone, there is obvious skin improvement so I could of mistaken healed past whiteheads or pimples for these bumps. Therefore, these bumps may have never changed over time. 

My right side of my body has more of them than my left side. The middle right side of back is extremely scarred by these. My back acne was particularly more severe on my right side. It was the opposite for my face. 

I never tried to treat these scars. I only tried to get rid of the acne. I saw a few dermatologists who told me they can't fix it and it's acne scarring. I listened to the words of my parents who didn't want me to go on Accutane and they claimed the acne and scarring will go away. Well, 20 years have passed and my scars are still there and I still brake out. Bottom line is that once acne becomes severe, be prepared to be scarred for life. I heard horror stories of Accutane so I can't praise this drug as a miracle cure neither. If I have taken it maybe I wouldn't be stuck with so much scarring but might of had far worse health conditions. 

Let's just say that acne hurts more emotionally than physically and it leaves you with disgusting scars to remind you that you are powerless to its power. 

I don't think laser resurfacing will help. That's essentially creating a bigger scar to camouflage the smaller ones so everything looks more even. I believe freezing them and scrapping them off might help. UV lighting might burn them off.

I have been sunburned in the past where I had millions of these bumps and none can be seen today. The ones that tend to linger around have significantly been reduced because of the skin flaking. Once again, this could be my imagination too. Getting tanned in that essence may be helpful because It seems to me my upper arms have less of them today as well as my upper back. Now, I am not telling you to go out there and burn yourself under the sun. I'm just sharing my experience. I'm self conscious of them and rarely take off my shirt. I can only hope that some scientist finds some potion to scrub on these bumps so they can vanish overnight. 

Edited by Anonymouz1

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Thank you Anonymouz1 !!!!!
Your story and experience is EXACTLY what I’m going through and I can’t find anything useful. It’s comforting to gain a bit of knowledge while we’re waiting on the dermatology community. 
Mine started around age 30 (6 years ago.) I’ve NEVER had bad acne, barely any at all. A few pimples will randomly occur alongside these and I regretfully popped/picked at them so I assumed it was the consequence. But the bumps don’t ever head or have pus, so I assume it’s not traditional acne, but related.  I can see hair and healthy pores so that’s a good sign. It flares up in cycles, some go away. 
Best I've found is to use sterile tweezers and unclog the pore from underneath, but that sometimes backfires. So I’m going off the assumption that it’s the acne bacteria. 
Fingers crossed that there’s soon more research on follicular atrophy (?) and we’ll find some answers and treatment. 
Thank you again, you’ve helped me sooo much. 

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On 04/09/2018 at 9:07 AM, RandaATX said:

Thank you Anonymouz1 !!!!!
Your story and experience is EXACTLY what I’m going through and I can’t find anything useful. It’s comforting to gain a bit of knowledge while we’re waiting on the dermatology community. 
Mine started around age 30 (6 years ago.) I’ve NEVER had bad acne, barely any at all. A few pimples will randomly occur alongside these and I regretfully popped/picked at them so I assumed it was the consequence. But the bumps don’t ever head or have pus, so I assume it’s not traditional acne, but related.  I can see hair and healthy pores so that’s a good sign. It flares up in cycles, some go away. 
Best I've found is to use sterile tweezers and unclog the pore from underneath, but that sometimes backfires. So I’m going off the assumption that it’s the acne bacteria. 
Fingers crossed that there’s soon more research on follicular atrophy (?) and we’ll find some answers and treatment. 
Thank you again, you’ve helped me sooo much. 

Hi Randa, 

What you describe seems to be related to yet another common skin condition known as keratosis pilaris. Its not acne at all but is due to clogged pores as well. The skin produces too much keratin which blocks the pores resulting in little red, black or white bumps which resemble blackheads, whiteheads or little pimples. Many people have this condition and refer to it as "chicken skin".

The condition doesn't leave scars behind unless you pick at the bumps. Picking makes you more prone to infection. The bumps become bigger and inflamed. Once the skin heals, scars can form and hyperpigmentation can last for months. 

Some people change diet and the condition improves while others use topical creams with mixed results. 

This is what keratosis pilaris looks like. 

images.jpg.4900b6ed5eb46d88aada9e7514ce2fea.jpg

This is what mid dermal elastolysis/follicular macular atrophy or perifollicular elastolysis looks like. 

images(2).jpg.e61c961899845eddea3af5b4b060cb4a.jpg

All of those terms are commonly used to describe a type of acne body scarring following healed cysts and nodules. Mind you new terms have been recently introduced by dermatologists. Medical literature calls them papular acne scars or papular hypertrophic scars now. Some people have these scars on their jawline and chins. They are rarely found on the face however. 

Here's a better picture of what these scars really look like. 

images(3).jpg.70d4a48ebc8fedefb09d3c83adb380b4.jpg

These scars are similar to yet another uncommon skin condition known as anetoderma. It looks like this. 

images(5).jpg.70ada60adb22b5fb7fc544d1313b94cf.jpg

In anetoderma, the elastic skin fibers are damaged spontaneously resulting in sunken or raised patches of skin. When stretched, the lesions vanish. It can take years for the lesions to develop. The condition can be progressive, slow or rapid. Scientists have been working hard to find the cause behind this but don't seem to have a clue yet. Anything from an auto-immune reaction to staphylococcus bacteria have been proposed. There are no treatments and a cure seems to be years away. 

Follicular macular atrophy is a scarring process following healed nodules and cysts. The healing outcome has similar properties as anetoderma. The elastic fibers of the skin are damaged resulting in raised or sunken patches of skin. These scars are often confused with hypertrophic scarring. The only way to tell is that hypertrophic scars are thick and dense while these scars are soft to the touch and disappear when stretched. 

My back is a lot better than the pic I posted above however I've got many of these raised spots like Anymouz1. I have them on the sides of my back, shoulders and upper arms. I've also got some on my thigh and jawline. 

Like Anymouz1 suggested, tanning makes them less noticeable but I also suffer from keratosis pilaris on my back. The bumps tend to blend with the acne scars which makes it hard to tell if I have keratosis pilaris or an acne scar. Like Anymouz1 mentioned, some lesions have flattened over time, some have not changed however. Current treatments don't do much. Steroid injections can flatten them. Ablative lasers remove the top layers of the skin, so may remove the loose skin altogether resulting in a smoother skin appearance after healing. I haven't had any treatments myself on these scars. 

I've also read that a new treatment using a hyfrecator can burn the loose skin off. The lesions therefore become invisible. 

 

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2 mm biopsy to confirm diagnosis. If loss of collagen, (this give the atrophic nature of the lesion) then you have a few choices. This condition is vvvvv common, more than what is reported in the literature. 
1. CO2 test patch or RF microneedling - Test patch - 3 sessions. 
2. VVV dilute Sculptra injections 1 to 18 dilution
3. VVV dilute Radiaesse injections. Once again test spot. 

Everyone will react differently. If there was one best solution..... well then only one solution will be published. Options 2 and 3 off label, so see a dermatologist that can think laterally - Dr Steve Weiner in the United States. Don't goto CA for up sell. Keep it simple. 

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