Will a Phenol Peel Work on Removing White Scars on Arm? (photo)

Question

I have old self-injury scars (it was a one time thing, I got therapy and am fine now). However, the physical scars still linger and I'm wondering if a phenol peel can help. I have flat white scars on my lower arms and slightly raised white scars on my upper arms.

Nelson Lee Novick, MD · Answer

Hypopigmented areas on the body, particularly on the arms and legs, whether resulting from chronic sun damage, chemical peels, laser treatments, or trauma are very difficult to treat and success with most modalities has unfortunately been limited. Lasers, chemical peels, and surgical excision have all been tried. Each carries a risk of scarring and loss of pigmentation.

	For several years I have had some success with hypopigmented lesions of all kinds, including vitigo, using medical microneedling coupled with application of tyrosine (an amino acid that is involved in the production of melanin). Medical microneedling, (see elsewhere in RealSelf for a detailed discussion) which can be performed manually using instruments such as the Dermaroller or by machine, the Dermapen, possesses two potential benefits. For one thing, it leads to the formation, as its name suggests, of microchannels within the skin that allow for the potential enhanced penetration of substances applied to it at the time of treatment and for up to several hours afterward. And while, to my knowledge, this hasn't been studied, there is the potential that the small needles on these devices may potentially transfer pigment producing cells from the surrounding skin (autoinnoculation) when the device is being moved back and forth over the border between the depigmented and normal skin. In the case of scars, medical microneedling may offer a third benefit of breaking up the scar tissue and promoting, new, collagen synthesis (a process known as collagen induction therapy), which may further improve the appearance of the treated areas. 

	To increase the likelihood of success with this approach, I typically recommend the supplemental use of tyrosine for home use along with a home roller with  a needle length no less than 0.5mm (less than this does not penetrate sufficiently to create the channels necessary for enhanced penetration).

	In general a series of at least four to six treatment sessions is required at six week intervals--a time sufficient to allow for maximum collagen synthesis in response to the microneedling. I typically test the treatment protocol on a representative lesion to gauge response before embarking on treating all lesions.

George Commons, MD (retired) · Answer

Phenol will not work.....period.   This type of scaring is very difficult.  There has bee some success using a Retin A  - Hydroquinone preparation daily for 1 to 3 years and then maintenance.  This lightens and blends surrounding areas.  It helps.   There is not much else to do.  You might consult with a dermatologist who is skilled with laser and surface treatment.  I think you can be blended to lessen the scars.    At times I have seen attempts to convert the scars to a more general injury pattens and less threatening.   Go the Retin A - Hydroquinone route with a great respected dermatologist in your home area.  Persistence will pay off.   The cream program is not very expensive but other surgical conversion costs or laser can add up.  My Best,  Dr C

Will a Phenol Peel Work on Removing White Scars on Arm? (photo)

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Will a Phenol Peel Work on Removing White Scars on Arm? (photo)

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