What is the best treatment for acne scars if I still have acne outbreaks? (photo)

Doctor's Answers (5)

Dr Stephanie Ho

"Skin specialist with over 20 years of experience"

Sorry to see that you are still suffering from acne and acne scarring.
I believe you need to restart the isotretinoin and we need to review the dosage and duration. From your photos, you continue to have a lot of underlying comedones (blackheads) and these need to be addressed. With the right combination of treatment, I believe you can control your acne successfully. 
Once the active acne is controlled, you can then focus on the acne scarring which can be improved with a combination of subcision, punch excision and fractional CO2 laser to treat the different types of scars.
Do let us know if we can be of help. Hope you get better soon!
Warmest regards
Dr Stephanie Ho, Dermatologist

From the photos it seems to me your acne breakouts are still quite active, and I will not advise treating your acne scars before addressing your acne breakouts. This is because:

  1. some of the acne scarring treatments can irritate the skin and even cause breakouts themselves. 
  2. if acne is undertreated, newly formed acne lesions can develop into new acne scars 

Isotretinoin is an effective treatment for cystic acne. But for it to work well, it has to be administered at the correct dosage and optimal duration. In my practice, I do regular monitoring of my patients' skin as well as blood profile to ensure the are responding well to treatment, without side effects. Besides Isotretinoin, I usually employ an array of tools to deal with acne vulgaris :

  1. Oral medications to regulate excessive sebum production (ie isotretinoin)
  2. Oral antibiotics to reduce the P.acnes bacteria load on the skin
  3. Effective home-use skincare to keep your pore clean, and reduce hyperkeratinization, the first step in the formation of a blackhead/whitehead
  4. Medical extractions for stubborn acne lesions for quick relief of pain and cosmetic symptoms
  5. Laser/light treatment to be added on if there is benefit to the patient
  6. Modification of lifestyle factors. E.g. some young men tend to take whey protein supplements, which can worsen their existing acne conditions. I will advise them to hold off their protein supplements while on treatments.

It is unlikely that all therapies stated above will be used at the same time. Customization of treatment plan according to patient skin condition and lifestyle will give the best results. After your acne is under control, we can definitely go into a detailed discussion about treatment modalities for acne scarring.

Hope that helps. Get well soon!

Best regards

Dr Heng Wee Soon

Dr Justin Boey

"Doctor with interest in Aesthetics and Lasers"

My advice is to achieve good control of your acne before we start scar treatments. 

To achieve good control of your active acne, you would most likely need to restart isotretinoin. If this does not help, you might need other treatments like chemical peels and Hydrafacial for better results with Acne.

After your active acne has come under good control, you can start Acne Scar treatments.

Check out this comprehensive guide of Acne Scar treatment Costs in Singapore.

Get well soon!

Warmest regards, 

Dr Justin Boey

Yes you are a very typical case of patient we see all the time. Someone who went to a hard-sell non medical salon for acne treatment - it's not surprising that you got no results.

Oral medications like isotretinoin often will give results but there must be follow up management because acne issues are often a constant and chronic problem depending on lifestyle and many external factors.

The tricky part is that before you treat acne scars, active acne must be controlled or new scars will be formed. Furthermore, some acne scars treatment like fractional CO2 laser which is one of the gold standard for acne scars.

Therefore you need to manage your acne control first with medical facials, topicals and maybe oral first and once the active acne is well controlled, we can look at treating the acne scars.

you could consider treating the existing acne lesions with topical and oral antibiotics as it currently doesn't look too bad. The alternative which I would consider is a prolonged period of LOW dose isotretinoin (minimising side effects while maintaining efficacy).

Your acne scars will definitely need subcision + fillers, fractional lasers and TCA cross to target the depressions/atrophic scarring, and icepick scars.

Consult your derm or aesthetic doctor and discuss your expectations AND constraints (social needs and budgetary)


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