White scars and hypopigmentation (loss of skin coloring) can result from trauma to the skin.
Scars
take on a white appearance because melanocyte production has been
impaired. Melanocytes make melanin- the pigment that gives the skin its
color. If melanocytes are damaged, so is the skin's ability to produce
darker skin tones.
After damage to the skin, whether or not hypopigmentation or white scarring occurs depends on how the injury took place.
Causes of hypopigmentation and white scarring
For
example, if you were riding a bicycle, fell and only scrapped your
knee, this would have created a superficial abrasion on the skin. A scab
would develop to protect the wound. Over the course of the few days,
the scab would fall off. Once the scab shed away, the skin would then
produce pigment in response to sun exposure and eventually, the color of
the scar would match that of the rest of the skin.
On the other
hand, had the bicycle fall involved a deep gash to the knee, most of the
pigment producing layers of the upper skin would be damaged while the
deeper layers of the skin would need to repair the injured tissue.
To
start the dermal repair process, the skin would then knit together
collagen and elastin to protect blood vessels beneath the skin. If blood
vessel damage occurred, increased amounts of inflammation would
accompany the wound healing process. Under these circumstances, a mild
form of fibrosis, or excessive scarring, may happen because of the
increased in skin damage and inflammation.
With this build-up of
scar tissue, melanocytes may not reach the surface of the skin where
they make melanin and give color to the skin. This results in white,
coarse scar tissue.
Laser resurfacing & hypopigmentation
Unlike
bicycle accidents, laser re-surfacing is a form of intentional
scarring. Since laser resurfacing corrects skin damage by inflicting
tiny wounds in the skin, laser treatments can cause hypopigmentation. At
times, the hypo-pigmented spots may not show up until two to six months
after the laser treatment.
Treatments for white scarring and hypopigmentation
Treatments
for white scarring that result from acne scars or accidents include
medications for vitiligo. Vitiligo is a skin disorder of unknown cause
involving loss of pigmentation in patches of otherwise normal skin.
Dermatologist Dr. R.W. Urbanek, reported to E Skin and Allergy News
that a product know as V-Tar helps combat the effects of
hypopigmentation. According to Dr. Urbanek, this compound causes the
skin to produce melanocytes which in term create melanin and restore the
skin's normal pigmentation.
Dr. Urbanek has seen improvements
with using V-Tar in as little as eight daily applications. However, side
effects of V-Tar include a burning sensation when exposed to direct
sunlight. This can be mitigated with using a sunscreen. You can ask you
doctor for V-Tar.
Ironically, when hypopigmentation results from
skin resurfacing, the treatment could involve more laser resurfacing. In
a study published in Dermatologic Surgery, Dr. James E. Fulton revealed his method for treating hypopigmentation that resulted from laser or chemical skin resurfacing.
Dr.
Fulton gave 22 patients who had hypopigmented scars a pre-treatment
with a vitamin A and glycolic acid lotion. Next, the patients received a
series of laser and chemical resurfacing treatments. After the
resurfacing treatments, researchers specially bandaged the treated
hypopigmented scars and allowed them to heal.
At the conclusion of
the study, melanocytes did return to the previously hypopigmented area
and ultimately the skin spot blended with the rest of the skin's natural
tone.
Preventing hypopigmentation and white scarring
Since
hypopigmentation and white scarring have historically proven themselves
difficult to cure, the best treatment is really prevention. You can
help prevent hypopigmentation by properly bandaging deep wounds
immediately after they happen. In the case of skin resurfacing, ask your
health practitioner what steps she is taking to avoid post
hypopigmentation and what you can do, in addition to wearing a good
sunscreen, to prevent possible hypopigmentation.
Sources:
Norra MacReady. Tar Product Tackles Hypopigmentation Quickly. E-Skin and Allergy News: March 2002, Vol 33, no 3, p 39.
Fulton J.E., A.D. Rahimi; S. Mansoor; P. Helton; P. Shitabata. The Treatment of Hypopigmentation After Skin Resurfacing. Dermatologic Surgery. January 2004, Vol 30, no 1, pp 95-101(7).
