No two outbreaks of acne are exactly alike and may require customised treatment plans. Similarly, the management of active acne versus acne scars requires different approaches. A DoctorxDentist reader asked how doctors determine treatment for active acne and acne scars, and recalled how some clinics offer one-size-fits-all treatment packages. In reply, Dr Justin Boey discussed the treatments for different stages and types of acne available to patients in Singapore. Here’s our round-up.
Active acne is treated first before anything else
Left unchecked, active acne can cause more severe scarring. This is why your active acne can be treated first before any scars left by previous breakouts. 
In addition, certain acne scar treatments such as ablative lasers could potentially trigger active acne flares.
Creams are considered a first-line treatment for active acne
In Singapore, active acne is usually managed through the use of creams first. Creams such as benzoyl peroxide gel, clindamycin gel, Differin cream, retinoic acid, and even Epiduo (a combination of retinoic acid and benzoyl peroxide) are effective for many. 
If topical creams do not work, oral medication may be added
If skin creams for acne are not sufficient, ask your doctor if antibiotics such as doxycycline and erythromycin are appropriate for your situation. If your acne symptoms do not improve, oral isotretinoin (commonly known as Roaccutane) may help. 
Acid peels and nonablative radiofrequency may help to reduce active acne
Chemical peels such as glycolic acid peels and salicylic–mandelic acid combination peels have been shown to be effective against the emergence of active acne and scarring. 
Another option for active acne besides these chemical peels is nonablative radiofrequency treatment, which uses radiofrequency as a source of energy to treat the skin with minimal downtime. 
How are acne scars treated?
There are many options available for acne scar removal that range from lasers and fillers to injections. Methods can be combined. Ask your doctor how he or she customises your treatment plan for each scar type you have. 
Lasers are effective for rolling scars
Atrophic acne scars can be effectively treated with laser treatments such as Fractional CO2, INFINI Fractional RF, and Fractional PicoLaser procedures. 
Fillers can deal with ice pick scars and boxcar scars
These are deep scars that have been tethered down by fibrous tissue. They can be managed through the use of a subcision procedure with fillers. Alternatively, TCA Cross and Fractional CO2 treatments work just as well. 
There are treatments for less common scars too
Pigmented brown scars (such as post-inflammatory hyperpigmentation) can be treated with the application of the PicoPlus laser, while hypertrophic scars such as keloids can be managed with corticosteroid injections applied by an experienced doctor. 
A combination of treatments may be required
Dr Boey mentioned that most patients have a combination of scars, which is why a combination of treatments may be needed in order to target various types of scars with precision. He combines several types of lasers and peels in each session for optimal results. 
Both active acne and acne scars can be effectively treated through the use of medically tested medications and technologies. Consult your doctor and get a proper evaluation of your condition before opting for any of these procedures, and remember to plan for possible downtime after each round of treatment.
Treatment results may be gradual instead of immediate, so patience is much advised before you can see long-term improvements.
Dr Justin Boey’s practice of aesthetic medicine centres around the busy modern individual. He is experienced in Facial Aesthetics (lasers and injections) and hair loss treatments. Learn more about him here.
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