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Atrophic pharyngitis — Clinical Guidelines

Overview

Atrophic pharyngitis, often seen in the context of atrophic scars, involves the destruction of collagen fibers and reduction in epidermal cells, leading to dermal depressions and significant aesthetic concerns. Treatment challenges persist due to the incomplete regeneration achieved by conventional methods.

Diagnosis

Clinical assessment focusing on the appearance of white, depressed scars.

Patient history to identify underlying causes (e.g., acne, trauma, surgery).

Grading systems such as the Goodman classification for acne scars 6.

Management

First-line treatments:

- Microneedling: Effective when combined with autologous platelet-rich plasma or anti-fibrotic drugs like 5-FU 2 5. - CROSS (Chemical Reconstruction of Skin Scars): Application of high-strength trichloroacetic acid (TCA) for focal treatment, particularly effective for ice-pick scars 3 4.

Adjunctive treatments:

- Fractional laser photothermolysis: Utilizing 1,550-nm erbium-doped fiber laser for resurfacing and improvement in scar appearance 7. - Ultrapulse CO2 laser: Effective for resurfacing and scar remodeling, though recovery times vary 3.

Special Populations

Pregnancy: Limited evidence; treatments should be conservative and avoid systemic agents [No specific data provided].

Pediatrics: Microneedling and CROSS methods may be considered with caution, focusing on minimal adverse effects [No specific data provided].

Elderly: Skin fragility should be considered; treatments like microneedling and fractional lasers may require adjustments in intensity and frequency [No specific data provided].

Comorbidities: Patients with conditions affecting wound healing (e.g., diabetes) may require individualized treatment plans with close monitoring [No specific data provided].

Key Recommendations

Combine microneedling with autologous platelet-rich plasma for optimal scar improvement (Evidence: Moderate 5).

Use CROSS technique with 50% TCA concentration to reduce adverse effects while maintaining efficacy (Evidence: Moderate 4 6).

Consider fractional laser therapy for patients with mild to moderate atrophic scars, assessing improvement over multiple sessions (Evidence: Moderate 7).

Tailor treatment intensity and frequency based on patient age and comorbid conditions (Evidence: Expert opinion).

References

1 Jafarzadeh A, Hoseini SS, Behrangi E, Roohaninasab M, Goodarzi A. Regenerative Medicine for Atrophic Scars: A Systematic Review of Extracellular Vesicles, Conditioned Media, Stromal Vascular Fraction, and Mesenchymal Stem Cells. Aesthetic plastic surgery 2026. link 2 de Souza LG, Gold MH, Steiner D, Silva MR, Viana de Oliveira G. A simple drug-delivery microneedling technique modality successfully improves linear atrophic scars. Journal of cosmetic dermatology 2024. link 3 Zhang MX, Hu X, Wang Y, Chen L, Shao WN, Chen CY et al.. Evaluation of combining ultrapulse CO. Lasers in medical science 2024. link 4 Chung HJ, Al Janahi S, Cho SB, Chang YC. Chemical reconstruction of skin scars (CROSS) method for atrophic scars: A comprehensive review. Journal of cosmetic dermatology 2021. link 5 Ibrahim ZA, El-Ashmawy AA, Shora OA. Therapeutic effect of microneedling and autologous platelet-rich plasma in the treatment of atrophic scars: A randomized study. Journal of cosmetic dermatology 2017. link 6 Fabbrocini G, Cacciapuoti S, Fardella N, Pastore F, Monfrecola G. CROSS technique: chemical reconstruction of skin scars method. Dermatologic therapy 2008. link 7 Alster TS, Tanzi EL, Lazarus M. The use of fractional laser photothermolysis for the treatment of atrophic scars. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] 2007. link 8 Tanzi EL, Alster TS. Single-pass carbon dioxide versus multiple-pass Er:YAG laser skin resurfacing: a comparison of postoperative wound healing and side-effect rates. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] 2003. link 9 Goodman GJ. Blood transfer: the use of autologous blood as a chromophore and tissue augmentation agent. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] 2001. link

Atrophic pharyngitis