How to Care for Aplasia Cutis Congenita Scars

Once an aplasia cutis congenita (ACC) wound has completely closed, long-term care shifts to protecting the resulting scar tissue. Because this healed skin is significantly thinner and more delicate than normal skin, it requires daily moisturization, strict sun protection, and routine monitoring to stay healthy as your child grows ^[1][2].

Understanding the Healed Tissue

When ACC heals, it usually leaves behind an atrophic scar—meaning the skin is thinner, slightly sunken, and lacks the robust layers of healthy tissue ^[1]. This area also typically lacks normal skin structures, such as hair follicles, sweat glands, and oil glands ^[2]. Because of this, the scar is more prone to drying out, cracking, and being injured by minor friction or bumps.

Daily Dermatological Care

To protect this fragile tissue and prevent it from breaking down, incorporate these gentle habits into your child’s daily routine:

• Regular Moisturization: Because the scar cannot produce its own natural oils, apply a bland emollient (a thick, fragrance-free moisturizer or ointment) every day ^[3]. This helps maintain the skin’s barrier function, trapping moisture in and keeping environmental irritants out ^[4]. Plain petroleum jelly or thick creams designed for sensitive skin are often recommended.
• Strict Sun Protection: The scarred skin often lacks natural protective pigmentation and standard thickness, making it highly vulnerable to sunburns and ultraviolet (UV) damage. Always protect the area when outdoors. For infants under six months, rely on UPF-rated, wide-brimmed hats that fully cover the top of the scalp, along with seeking shade. Once your baby is old enough, apply a broad-spectrum, mineral-based sunscreen (like zinc oxide) directly to the scar, in addition to wearing hats ^[1][3].
• Everyday Hygiene and Hair Care: When washing the area, use mild, fragrance-free cleansers. Avoid scrubbing the scar or using harsh soaps that can strip away the skin’s minimal moisture ^[4]. It is safe to gently brush the normal hair surrounding the bald spot, but use care to avoid scratching the delicate scar tissue with the brush bristles.

Long-Term Monitoring and Safety

As your child grows and becomes more active, the scar will stretch and change. Keeping a close eye on the area is a vital part of long-term care.

• Watch for Scar Breakdown: Check the scar regularly for any signs of dryness, cracking, redness, or spontaneous bleeding. Because the tissue is so thin, it can easily break open from minor friction or trauma ^[1]. If the skin does crack or bleed, clean the area gently, apply your regular emollient or a sterile bandage, and contact your pediatrician or dermatologist for next steps.
• Protecting the Skull: If your child’s ACC involved an underlying defect in the skull bone, the scar might be the only barrier protecting the deeper tissues ^[5]. In these cases, a multidisciplinary medical team will guide you on specific safety measures to prevent physical trauma, which may include wearing custom protective headgear as your child learns to walk ^[6]. Fortunately, smaller bone defects often fill in naturally as the child grows. Note: If your child’s ACC did not involve a bone defect, they do not need specialized headgear and can participate in normal infant activities like tummy time without extra head protection.
• Look for Persistent Changes: While most ACC scars remain stable for a lifetime, there are very rare cases where chronic scars can develop into a type of skin cancer called cutaneous squamous cell carcinoma ^[7]. Close, lifelong monitoring of the scar is essential. If you notice a new bump, a sore that won’t heal, or a sudden change in the scar’s texture, have it evaluated by a dermatologist promptly ^[7].

Future Options

If the hair loss (alopecia) or the appearance of the scar is a concern as your child grows, secondary interventions are available. Treatments such as tissue expansion or hair follicle transplantation can be discussed with a pediatric plastic surgeon or dermatologist to improve the skin’s quality and appearance ^[1][2]. These procedures are often considered later in childhood or adolescence, depending on the child’s individual needs and the size of the scar.