Treating Atrophic Scars While Still Having Inflammatory Acne: Why Might This Be the Wrong Approach?

When acne is still actively flaring, treating atrophic scars immediately may be the wrong sequence of care. Ongoing inflammatory breakouts can easily generate new scars; therefore, the typical approach prioritizes gaining control over acne first to reduce inflammation and prevent further damage.

Key takeaways:

• Treating acne first helps reduce inflammatory responses and limits the risk of forming new atrophic scars on the skin.
• Depressed scars include various morphologies such as ice pick scars, rolling scars, or boxcar scars, which must be clearly differentiated from post-acne skin discoloration.
• Intervention plans should be based on scar types, age, skin tone, and the number of lesions, rather than applying a rigid, one-size-fits-all formula.

Differentiating active inflammatory acne from atrophic scar lesions

Many individuals often confuse active acne breakouts, post-acne discoloration, and true atrophic scars. According to the American Academy of Dermatology (AAD), flat discolorations remaining on the skin's surface after acne clears are not necessarily depressed scars. These are typically just surface-level pigmentary changes, whereas atrophic scars are depressed lesions formed when tissue structure is compromised following an inflammatory response.

Depressed scars are not uniform across all areas and present in several distinct morphologies:

• Ice pick scars: Small in diameter but extend deep into the skin.
• Rolling scars: Wide, shallow depressions that create an undulating, wavy skin texture.
• Boxcar scars: Round or oval depressions, wider than ice pick scars but narrower than rolling scars.

A single individual can present with multiple types of depressed scars simultaneously across the face. Accurately distinguishing ongoing inflammatory lesions from fixed scar types is an essential first step before deciding on an intervention for atrophic scars.

The risk of forming new scars when acne remains uncontrolled

The primary reason why rushing into scar revision during active acne breakouts is considered the wrong sequence lies in the injury formation cycle. According to the AAD, if acne is still actively flaring, the treatment journey generally begins with gaining control over the breakouts to reduce inflammation.

When inflammatory acne is not stably controlled, subsequent flare-ups continue to destroy the skin's architectural integrity around the inflamed hair follicles. As a result, while you are making efforts to improve existing scars, newly inflamed lesions may generate additional atrophic scars. Furthermore, continuing acne management after scar procedures have been performed is a vital recommendation from specialists to minimize the risk of developing new scars in the future.

Three scenarios a physician may consider

There is no single formula applicable to every case. However, during clinical consultations, a physician typically evaluates one of three approaches based on the patient's clinical presentation:

• Prioritizing complete control of inflammatory acne first: This is the most common scenario when the skin presents with numerous active breakouts. The objective is to quell the inflammatory response and prevent new tissue destruction before transitioning to the atrophic scar improvement phase.
• Managing acne concurrently with selective interventions: In certain specific cases, a physician may prescribe acne management concurrently with suitable methods to improve the underlying skin quality, depending on skin responsiveness and the extent of the damage.
• Focusing on atrophic scar treatment once acne is stable: When the skin is free from active inflammatory acne, the physician designs a targeted intervention plan addressing the depressions based on their actual scar morphology.

Determining which scenario is appropriate requires a careful clinical evaluation by the attending physician rather than subjective self-assessment.

A personalized plan rather than a rigid sequence

The AAD explicitly states that scar intervention plans must be individualized, considering multiple concurrent factors: scar type, scar quantity, anatomical location, age, skin tone, and personal goals. Ice pick scars and rolling scars may necessitate entirely different treatment modalities.

Depressed scars frequently require more than one treatment session or a combination of various techniques. The AAD lists numerous scar intervention methods, including chemical peels, dermal fillers, laser resurfacing, microneedling, platelet-rich plasma (PRP), radiofrequency, dermabrasion, and scar surgery aimed at elevating the scar from underlying tissue.

Following any procedure, strict adherence to post-care instructions provided by the treating dermatologist is crucial. Post-procedural edema or temporary discoloration may lead to inaccurate self-comparisons and visual evaluations during the early recovery stages.

References

• American Academy of Dermatology - Acne scars: Consultation and treatment
• American Academy of Dermatology - Acne scars: Signs and symptoms
• American Academy of Dermatology - Acne scars: How to care for your skin after treatment

Frequently Asked Questions

Can I undergo laser treatment while still having active acne?

According to the AAD, when acne is actively flaring, the standard approach is to control the acne first to reduce inflammation and prevent new scar formation. Your physician will directly evaluate the severity of your acne to determine the appropriate timing for laser resurfacing.

Is post-acne redness considered an atrophic scar?

No. Flat color changes on the surface of the skin after acne clears are not necessarily atrophic scars. Atrophic scars are true tissue depressions caused by structural deficits beneath the skin, such as ice pick scars, rolling scars, or boxcar scars.

Can acne and scars be treated simultaneously?

The intervention plan depends on the individual, including scar type, scar count, skin tone, and current inflammatory status. While controlling acne is generally prioritized to prevent new scarring, a physician can design an appropriate combined regimen following an in-person clinical assessment.

Content compiled by the BonBoz Clinic Editorial Board and cross-referenced with medical sources cited in the article.

This content is for reference purposes only and does not substitute for an in-person examination and medical consultation with a physician.