Acne scars remains one of the most challenging condition to treat. In short, there is no one single treatment that is best for everyone. That being said, I see many patients whom are extremely frustrated after trying treatments that are not effective for their type of acne.
The carbon dioxide (CO2) laser is an effective treatment for atrophic (slightly depressed) scars. In the recent years, it has been used less as others are trying “simpler” procedures with little or no downtime, although with far less benefit. In this study over 77% of participants reported at least mild improvement, while 40% of the participants noted moderate to significant improvement.
That being said, this is not the only treatment for this type of scarring. Dermabrasion and medium depth chemical peels (i.e. TCA – trichloroacetic acid) are good options as well. Short term options include fillers, such as Restylane.
Citation: Elcin G, Yalici-Armagan B. Fractional carbon dioxide laser for the treatment of facial atrophic acne scars: Prospective clinical trial with short and long-term evaluation. 2017;32(9):2047-2054. doi:10.1007/s10103-017-2322-7.
Finally, patients are able to self-treat mild to moderate inflammatory and comedonal acne with over-the-counter treatments.
Blackheads and whiteheads can now be treated effectively with Differin gel, which went over-the-counter earlier this year. This medication is similar to Retin A, the drug everyone knows about. These medications help to unclog pores are and more effective than any other over-the-counter medication.
Inflammatory lesions, such as red bumps and pustules, can be treated using a 5% benzoyl peroxide gel (use 5% or less as higher concentrations result in more skin irritation).
I do not recommend spot treating as acne is a chronic disease, so the idea is to treat the lesions that one has, but we also want to prevent new lesions from coming up.
Those with cystic or very inflammatory lesions will benefit from oral antibiotics and/or Accutane, both of which require a prescription.
Those with scarring should seek professional advice from a board-certified Dermatologist as soon as possible.
For decades, we have told patients that there were no studies to support that drinking soda made acne worse, although if that was their experience then they should not consume soda. Over the recent years, more and more evidence has emerged showing that diet can affect acne. The first study showed that drinking non-organic milk may exacerbate acne. Recently a study published in the The Journal of Academic Nurtition (J Acad Nutr Diet. 2017 Jun 9. doi: 10.1016/j.jand.2017.03.024 ) showed that consuming high-glycemic index carbohydrates is correlated with worsening of acne.
In short, the recommendations have not changed–for all persons, eating a good healthy diet is recommended. What has changed is the evidence showing that poor eating habits is connected with worsening of acne. For all of my patients, acne or not, I recommend avoiding white rice, white potatoes, white flour, and sugar in their diet. Unfortunately, most of my patients, with or without acne, consume a large amount of these high-glycemic index foods, which contributes to obesity, fatigue, and the development of type II diabetes.