What can be done to improve hyperpigmentation, texture and raised scars from dermatillomania? (photos)

Question

Hi, I have terrible scars from ten years of dermatillomania. I understand I will have to live with these scars, but is there any treatment that can be done to improve appearance? I get a lot of hyperpigmentation and the old scars are raised and white.

Anna Chacon, MD, FAAD · Answer

Improving the appearance of hyperpigmentation, texture, and raised scars caused by dermatillomania (skin picking disorder) can be challenging but there are several treatment options that can help. Here are some strategies you might consider:

Hyperpigmentation

1. **Topical Treatments:**
   - **Hydroquinone:** Often considered the gold standard for hyperpigmentation, this topical agent can lighten dark spots.
   - **Retinoids:** Tretinoin or adapalene can help promote cell turnover and reduce pigmentation.
   - **Vitamin C:** An antioxidant that can help brighten skin and reduce pigmentation.
   - **Azelaic Acid:** Effective for both acne and hyperpigmentation.
   - **Kojic Acid:** A natural skin lightener that can help reduce pigmentation.

2. **Chemical Peels:**
   - Superficial peels using glycolic acid, salicylic acid, or lactic acid can help improve skin texture and pigmentation.

3. **Laser Treatments:**
   - **Intense Pulsed Light (IPL):** Can be effective for reducing pigmentation.
   - **Fractional Lasers:** Such as Fraxel can help with both pigmentation and texture.

Texture and Raised Scars

1. **Silicone Gel or Sheets:**
   - These can help flatten and soften raised scars over time.

2. **Intralesional Steroid Injections:**
   - Steroids can help reduce the size and hardness of hypertrophic scars and keloids.

3. **Microneedling:**
   - This can stimulate collagen production and improve texture. When combined with radiofrequency (RF), it can enhance results.

4. **Laser Resurfacing:**
   - **Ablative Lasers:** Such as CO2 or Erbium lasers can resurface the skin and improve scar texture.
   - **Non-Ablative Lasers:** Like fractional lasers can also help with texture with less downtime.

5. **Dermal Fillers:**
   - For certain types of scars, fillers can help to raise depressed areas.

6. **Microdermabrasion:**
   - Can improve skin texture and reduce the appearance of superficial scars.

General Skincare

1. **Sun Protection:**
   - Use a broad-spectrum sunscreen daily to prevent further pigmentation and protect healing skin.

2. **Moisturization:**
   - Keeping the skin well-moisturized can improve its overall appearance and support the healing process.

3. **Avoiding Picking:**
   - Continued picking can worsen scars and pigmentation. Seeking help for the underlying dermatillomania is crucial. Cognitive-behavioral therapy (CBT) is often effective for this condition.

Professional Consultation

- Consulting with a dermatologist or a plastic surgeon is essential. They can tailor treatments to your specific skin type and the nature of your scars.

Psychological Support

- Addressing the underlying dermatillomania is crucial for long-term improvement. Therapies like CBT, habit-reversal training, and sometimes medication can be effective.

Combination Therapies

- Often, a combination approach yields the best results. For example, combining chemical peels with microneedling or laser treatments with topical therapies can enhance outcomes.

It's important to have realistic expectations and understand that while significant improvement is possible, complete eradication of scars may not be achievable. A dermatologist can help guide you through the most appropriate and effective treatment plan for your skin.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

What can be done to improve hyperpigmentation, texture and raised scars from dermatillomania? (photos)

Answers (2)

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