A hole in a scar, often an indented or "punched-out" look, can happen from wound dehiscence (reopening of a surgical cut, common with infection or strain), poor healing, or deep acne, creating a atrophic scar like an ice-pick or boxcar scar, or even a tunneling wound where infection travels under the skin, but you should see a doctor to diagnose the cause and get proper treatment.
Wound dehiscence is a complication of surgery. In wound dehiscence, your closed surgical incision (cut) opens after surgery, exposing internal tissues and possibly exposing organs.
Risk factors for tunneling wounds
Risk factors for developing tunneling wounds include advanced age, immobility, poor nutrition, incontinence, and underlying medical conditions such as diabetes. Other risk factors include infection and a wound that does not have proper moisture balance.
The following are some of the more common scar-minimizing procedures:
Some raised scars itch or feel painful. If the scar is large or forms on a shoulder, elbow, or other joint, it can restrict your movement. If you experience any of these problems, you should see a board-certified dermatologist.
Old scars break open in scorbutic patients because (1) the rate of collagen degradation is greater in an old scar than it is in normal skin, and (2) the rate of collagen synthesis is diminished throughout the body in ascorbate deficiency.
Treatments can reduce a scar's size or appearance, but the scar will never completely go away. Some treatments prevent a scar from forming as a wound heals.
Treatment
Injecting collagen, fat or other substances under the skin can plump the skin over indented scars. The goal is to make the scars less noticeable. Results are temporary, so repeat treatments are needed to retain the effect. This method has little risk of changes in skin color.
When cared for properly, most wounds heal well, leaving only a small scar or none at all. With larger wounds, you are more likely to have a scar. Certain factors can prevent wounds from healing or slow the process, such as: Infection can make a wound larger and take longer to heal.
Skin depressions present with a concave shape that can look like holes or indentations in the skin, and can be due to pores of oil glands, certain skin cancers, infections, and acne scarring.
A break in your skin that is slow to heal or fails to heal is called a skin ulcer. Ulcers usually look like a small, round crater in the skin with rough edges. They sometimes bleed or ooze and can become inflamed.
Bad scars are ones that are particularly noticeable for any reason. These are typically widened, raised, discolored (red, pink, brown, black), depressed (divot), irregular, or in a conspicuous location (for example, middle of the cheek).
Tunneling is often the result of infection, previous abscess formation, sedentary lifestyle, previous surgery at the site, trauma to the wound or surrounding tissue, or the impact of pressure and shear forces upon many tissue layers causing a “sinkhole-like” defect on the skin.
Larger or Deeper Wounds
The initial stages of healing are the same, but the proliferation and maturation phases are much more extensive. A deep wound may take several weeks to a month to close completely. The maturation phase, where the new scar tissue strengthens and fades, can take up to a year or more.
A skin wound that doesn't heal, heals slowly or heals but tends to recur is known as a chronic wound. Some of the many causes of chronic (ongoing) skin wounds can include trauma, burns, skin cancers, infection or underlying medical conditions such as diabetes. Wounds that take a long time to heal need special care.
So, what is the hardest wound to heal? The answer lies in chronic wounds, particularly diabetic foot ulcers, pressure ulcers (bedsores), and venous leg ulcers.
To optimize wound healing, it is crucial to remove dead tissue through debridement, manage infection, and maintain a clean and moist wound environment. Negative pressure wound therapy (NPWT) is an advanced treatment approach that can be particularly effective for tunneling wounds.
Skin lesions that have a concave contour and appear to be holes or indentations are referred to as pockmarks. They develop when the skin's deeper layers are injured. Extra collagen is produced by cells in the skin's deeper layers when it begins to mend, which may leave scar tissue behind.
In most cases, pitted acne scars do not improve significantly without clinical intervention. While post-inflammatory hyperpigmentation (dark spots left after acne) may fade naturally over time, pitted scars involve a loss of underlying skin structure. This makes them much harder to resolve without targeted treatment.
Atrophic scars are sunken, pitted marks caused by the loss of underlying support like fat or muscle. Common after acne, infections, or injury, they reflect deeper skin damage and structural loss. An atrophic scar looks sunken and has a pitted appearance.
The etiology of cancers occurring in scars is not fully understood, although the prevailing hypotheses include prolonged proliferation due to chronic inflammation and irritation of tissue, ongoing exposure of tissues to toxins and co-carcinogens after the injury, and poor vascularization of the scar tissue resulting in ...
There isn't enough collagen left in your body to continue creating scar tissue, so old wounds may start opening.
It will take six to 18 months for the scar to have its final appearance. Your scar should gradually soften and fade over these six to 18 months, but will look pink initially (photo B). Some scars never fade. If your scar stays pink after 12 to 18 months please call to discuss options.