How do doctors determine the best treatment for acne and acne scars?Acne & Scars Skin, Hair & Nails
I have active acne, and acne scarring on my cheeks. I am confused about all the treatment options available, as well as places where I can seek treatment. How do doctors determine the recommended treatment for acne and acne scar issues? I hope experienced Doctors in this field can provide me with more information on this, as I understand that some clinics have particular treatment "packages" for acne and acne scarring that they push all patients towards. Please advice and thank you very much!
Acne - black-heads, white-heads, red bumps (papules), pustules and cystic.
Active acne can start from as early as 10 years old and most will self-resolve by the early 20s. The most effective treatment for this is medical. Medical treatment can be a combination of topical medications or combined with oral medication. The duration of treatment is usually for 6 months. Sometimes I add a series of chemical peels ie salicylic acid to expedite the treatment. This can be combined with LED light (blue color wavelengths) to target the bacteria on the skin.
Acne scarring - uneven texture on the skin after the active acne has resolved. It can either be bulging (hypertrophic) or depressed (atrophic). Run your finger along the skin and you can feel the indentations.
These are not easy to treat. Ablative lasers ie. CO2 and the Erb:YAG lasers are normally used to do a controlled ablation of the top and middle layers of the skin to allow a controlled healing of the skin to produce collagen and tightening. At our clinic we use a fractional Erb:YAG laser and combine it with a continuous mode Erb:YAG laser. There is downtime of about 1 week after the treatment and treatments are repeated every 6 weeks. I tell patients to expect a 40-50% improvement after a series of treatments.
Acne - post-inflammation hyperpigmentation
This is treated with depigmenting creams and sun protection. I would normally combine the creams with a series of chemical peels and the Dual Yellow laser to reduce the inflammatory redness that usually leads to the darkening of the skin.
I hope you have found this helpful.
Dr Benjamin Yim
I feel your pain, it's hard not to be confused with so much information out there on acne and acne scar treatments!
These are the principles that I follow for treating active acne and acne scars.
1. I treat Active Acne first, before treating Acne Scars.
- this is because active acne can cause more scars.
- certain acne scar treatments like ablative lasers can trigger active acne flares too.
2. Effective Active Acne Treatments in Singapore
I treat active acne with creams first, followed by oral medications and lasers if they do not improve.
- Benzoyl peroxide gel
- Clindamycin gel,
- Differin cream or a Retinoic acid
- Epiduo (combination of Retinoic acid and Benzoyl peroxide)
- Antibiotics (Doxycycline/ Erythromycin)
- If your acne does not improve or even worsens, you might have to consider oral Isotretinoin (commonly known as Roaccutane).
Chemical Peels and Lasers can also help.
3. Best Acne scar treatments are treatments that are customised for each scar that you have.
I tailor my treatments according to the type of scars that my patients have.
Rolling/ Atrophic Scars
Treatments of choice:
- Fractional CO2,
- INFINI Fractional RF,
- Fractional PicoLaser
Ice-pick and Boxcar Scars
Ice pick and boxcar scars are deep scars and tethered down by fibrous tissue
Ice pick scars
Treatments of choice:
- Subcision with fillers,
- TCA cross,
- Fractional CO2
Pigmented Brown scars – also known as Post-inflammatory Hyperpigmentation
Treatment of choice:
- PicoPlus Laser
Hypertrophic Scars/ Keloid
Treatment of choice:
- Corticosteroid Injection
In my experience, most patients have a combination of scars.
As such, a combination of treatments are needed to target the various types of scars precisely.
I usually combine several types of lasers and peels in each treatment session to achieve optimal results.
For more details, you can check out this comprehensive Guide to Acne Scar Treatment Costs in Singapore.
Hope that this helps!
Dr Justin Boey
There are so many treatments available right now and ultimately it is down to the type of acne/ acne scars you have and the downtime you can tolerate. The treatment plan should be customised as everyone has different type of scars.
Generally I will recommend TCA cross for ice pick scars, Fractional laser/ Microneedling RF for box scars, Subcision with filler for rolling tethered scars and Rejuran microinjection as a supplement to scar treatment.
The treatment for active acne depends on the type and severity of the acne. Topical creams for mild acne, oral medications for moderate to severe acne and steroid injection for stubborn cystic acne.
All these treatment options have their own pros and cons and downtime so it is important to clarify with the doctor before proceeding. Hope this helps!
Dr Jiwei Wu
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Dr Justin says it well.
Treat the acne first. IF not its an absolute waste of time chasing after the scars when new ones keep appearing. More often than not, products can play a large part in acne. Stick to a few products but gel-based are preferred.
I don't believe in "packages" for acne as everyone is different in acne types AND scar types. Sit down and discuss carefully with your doctor and don't sign packages etc IF you don't feel comfortable. understand your condition better and you would be able to make a wiser choice!
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