Effective Treatments and Creams for Acne Scars: What You Need to Know

Treatment of acne scars and selection of ointments?

Hello Dr.
Wu: I currently have some acne scar conditions that I would like to address.
I understand that atrophic scars can only be treated with laser therapy, which I am not considering for the time being.
For the pigmented red acne scars, after consulting with two doctors, I was prescribed azelaic acid.
However, after applying azelaic acid, my skin often becomes red for one to two days, and sometimes there is localized redness and swelling (although this also subsides in about two days, and it's hard to distinguish whether it's due to acne inflammation).
I have read the instructions, which mention that this can occur and that the skin will gradually adapt and improve.
However, after almost a month of use, my skin still reacts this way.
Therefore, I am wondering if this is an allergic reaction and if azelaic acid is not suitable for me.
Previously, I also purchased a product containing L-ascorbic acid, but after applying it, my skin also reacted with slight redness and small swelling.
Although this subsided after a couple of days, it made me hesitant to use it again.
I would like to ask the doctor if my skin is unsuitable for these two products, or if these reactions are normal and I can continue using them.
If they are not suitable, what other medications or skincare products targeting acne scars can I consider using?

kuza, 30~39 year old female. Ask Date: 2018/12/04

Dr. Wu Yuxin reply Dermatology

If it is irritating, you can try reducing the dosage, but you should seek medical attention to determine what treatment is suitable for you.

Reply Date: 2018/12/04

More Info

When it comes to treating acne scars, particularly post-inflammatory erythema (red acne scars) and atrophic scars (depressed scars), it’s essential to understand the various treatment options available and their potential side effects. Based on your experience with products like azelaic acid (often referred to as "杜鵑花酸" in Mandarin) and L-ascorbic acid (Vitamin C), it seems you are encountering some common reactions that many individuals experience when using these active ingredients.

Understanding the Treatments
1. Azelaic Acid: This is a dicarboxylic acid that has anti-inflammatory and antibacterial properties. It is effective in treating acne and can help reduce post-inflammatory hyperpigmentation. However, it can cause skin irritation, redness, and swelling, especially when first introduced to the skin. This is often a normal reaction as your skin adjusts to the product. If the redness and irritation persist beyond a few days or worsen, it may indicate sensitivity or an allergic reaction.

2. L-Ascorbic Acid (Vitamin C): This potent antioxidant is known for its ability to brighten the skin and improve the appearance of scars. Similar to azelaic acid, it can cause mild irritation, redness, or stinging upon application, particularly if the concentration is high or if the skin is not accustomed to it. Again, if these symptoms are severe or prolonged, it may be worth reconsidering its use.

Evaluating Your Reactions
Given your experiences with both azelaic acid and L-ascorbic acid, it is crucial to assess whether the reactions you are experiencing are typical or indicative of an allergy. Mild redness and swelling can be common, especially in the initial stages of using these products. However, if you find that these reactions are not subsiding or are becoming more pronounced, it may be wise to discontinue use and consult with a dermatologist.

Alternative Treatments for Acne Scars
If you find that azelaic acid and L-ascorbic acid are not suitable for your skin, there are several other options you might consider:
1. Niacinamide: This is a form of Vitamin B3 that can help improve skin texture, reduce redness, and enhance the skin barrier. It is generally well-tolerated and can be used alongside other treatments.

2. Retinoids: Topical retinoids (like tretinoin) can promote cell turnover and improve the appearance of scars over time. They can cause initial irritation, so it’s best to start with a lower concentration and gradually increase usage.

3. Chemical Peels: These can help exfoliate the skin and improve the appearance of scars. Peels containing glycolic acid or salicylic acid may be beneficial, but they should be performed by a professional to minimize the risk of irritation.

4. Hydroquinone: This is a skin-lightening agent that can help reduce hyperpigmentation. It should be used with caution and typically not for extended periods without a dermatologist's guidance.

5. Moisturizers with Ceramides: Keeping the skin well-hydrated can help support the skin barrier, especially when using active treatments that may cause irritation.

Conclusion
In summary, while azelaic acid and L-ascorbic acid can be effective for treating acne scars, your reactions suggest that your skin may be sensitive to these ingredients. It’s essential to listen to your skin and consult with a dermatologist if you have concerns about irritation or allergic reactions. They can provide personalized recommendations and possibly suggest alternative treatments that are better suited for your skin type. Remember, achieving clear skin takes time and patience, and finding the right products for your unique skin is key to success.

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