I Am Caucasian, I Have White Spots Puffed Scars Mainly on my Chest, Shoulders and Back.

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

You should obtain a culture, and  biopsy to get a diagnosis.  After a diagnosis, treatment can be planned.

There are definitely ways of determining what these white spots are.  The first thing to do is to have a dermatologist do a light scraping of the white spots and look under the microscope with the aid of a KOH (potassium hydroxide) stain to determine if there are any yeast forms present.  If there are, this would be tinea versicolor.

If there are no yeast forms on KOH examination, a biopsy of one such spot can be performed to see the nature of the lesion, particularly if you doubt that these may be acne scars.  There are inflammatory skin conditions that can result in lesions that look like white puffy scars, such as anetoderma or atrophoderma. 

I recommend a consultation with another dermatologist, perhaps one in an academic center.