Rolling scar

Rolling scars, usually wider than 4 to 5 mm, are the result of the abnormal fibrous anchoring of the dermis to the subcutis and give a rolling or undulating appearance to the overlying skin... 

Useful for rolling scars to free the fibrous bands that cause the scar. It is performed with a 18-gauge triangular tip needle that reaches the subcutaneous tissue and separates the fibrous cords. Once it is inserted through the dermal-subcutaneous junction plane, it is turned with the tip parallel to the skin surface. A piston-like motion is then used to release the fibers... 

Useful with shallow boxcar and rolling scars. CO2 and/or Er YAG lasers are utilized for this technique. After the treatment, silicone sheeting, gauze and tube netting are placed over the treated area and maintained for 24 h (the silicone sheeting remains for another 48 h). The patient is instructed to soak the treated area every 2-4 h with cold water for 20 min and then apply an occlusive ointment. Re-epithelialization is completed in 10 days. A new treatment can be performed after 6-8 weeks. 

Acne scars have been subclassified into ice pick, boxcar, and rolling scars [2]. Over the past several decades, numerous descriptive terms and classifications have been suggested for acne scars. We used the classification recently proposed by Goodman et al. [3]. This classification defines as Grade 1 macular scarring or flat scarring characterized by flat areas of increased or... 

Acne scars (ice pick, boxcar, and rolling scars)... 

A few morphologic acne scar classifications have been proposed to assess the efficacy of different therapeutic options based on the scar types. Standard classification includes three basic types of scars icepick scars, rolling scars, and boxcar scars [7, 8]. Icepick scars are narrow (<2 mm), deep sharply marginated epithelial tracts that extend vertically to the deep dermis or subcutaneous tissue (Fig. 18.1). Rolling scars occur from dermal tethering of otherwise relatively normal-appearing skin and are usually wider (4-5 mm) (Fig. 18.2). The subdermal tether precludes treatment from the surface above thus, correction of subdermal... 

Wooden applicator Boxcars, rolling scars, ice pick scars Easy to regulate the flow of TCA Prolonged treatment time... 

The best results are achieved in macular scars. Ice pick and rolling scars cannot disappear completely and need sequential peelings combined with homecare treatment with topical retinoids and alpha hydroxy acids. For the deepest ice pick scars, phenol peels can be very useful but require monitoring. 

Acne scars are best treated with dermabrasion. In many instances, a full-face mechanical dermabrasion is not needed and may be excessive. To simplify the procedure, a medium-depth chemical peel can be performed over the entire face and the scar units can then be resurfaced with dermasanding or dermabrasion. An example is the patient with rolling scars and ice pick scars on the medial cheek. The deepest ice pick scars are treated with punch graft... 

Generally, best results are achieved in depressed and atrophic or rolling and boxcar scars. Icepick scars always need to be preceded by punch excision. Our experience shows that in older patients, when skin is less elastic, it is possible to achieve more significant improve-... 

Fig. 9.11. A 44-year-old patient with rolling acne scars before (a) and 3 months after (b) deep chemical peel combined with subcision and dermabrasion...

Atrophic scars (icepick, rolling, boxcar) Hypertrophic scars (keloids)... 

Sherlock Holmes took his bottle from the corner of the mantelpiece, and his hypodermic syringe from its neat morocco case. With his long, white, nervous fingers he adjusted the delicate needle and rolled back his left shirtcuff. Lor some little time his eyes rested thoughtfully upon the sinewy forearm and wrist, all dotted and scarred with innumerable puncture-marks. Linally, he thrust the sharp point home, pressed down the tiny piston, and sank back into the velvet-lined armchair with a long sigh of satisfaction. 

Noninfectious indolent epithelial ulcers also can occur in HSK.These ulcers, formerly referred to as metaherpetic lesions, tend to be ovoid, 2 to 8 mm in size, with smooth rolled edges. They may be caused by damage to the epithelial basement membrane due to inflammation, tear film abnormalities, neurotropic cornea, or toxicity from antiviral medications. These ulcers may be recalcitrant, resulting in neovascularization and scarring. 

Figure 2 PVR with traction and retinal tear with rolled edges adjacent to cryopexy scar. Abbreviation PVR, proliferative vitreoretinopathy.

Esparta was rolling by below the plane, one of the lush national parks which surrounded the capital. A jungle scarred only by the occasional Roman-straight motorway and dachas belonging to the aristocracy. The ocean was five minutes behind them. 

Fig. 18.13 A 38-year-old patient with rolling and depressed distensible scars, (a) Before, (b) One month after deep chemical peel combined with subcision and skin abrasion...

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