Why treat acne before scars ?
Active acne must first be treated to prevent new scars from continuing to form. Treating existing scars does not prevent new scars from appearing if acne breakouts persist.
Scars form when acne-related inflammation damages the dermis. This risk is greater with deep lesions, particularly nodules and cysts.
As long as inflammatory spots continue to appear, the skin remains at risk of new scars.
The priority is therefore to control acne breakouts. Once acne is stabilised, existing scars can be treated.
Must you wait until there are no spots left ?
No. It is not necessary to wait until no spots appear, but inflammatory acne must be sufficiently controlled before scars are treated.
An occasional isolated spot must be distinguished from a true active breakout. The repeated presence of papules, pustules, nodules or cysts indicates ongoing inflammation and justifies treating the acne first.
Stabilised acne with a few occasional lesions does not necessarily constitute an active breakout. The decision depends on the number of lesions, their inflammatory nature and their location relative to the areas requiring treatment.
The American Academy of Dermatology states that scar treatment generally begins when breakouts are controlled and acne treatment is continued to prevent new lesions.
Why can an inflammatory breakout interfere with scar treatment ?
An inflammatory acne breakout can interfere with scar treatment because active lesions are still developing, whereas scar treatments are intended to remodel established scars.
Fractional lasers, continuous ablative laser treatment, peels and dermatological subcision techniques deliberately induce a skin reaction to stimulate tissue repair and collagen remodelling. Their aim is to act on an already formed scar.
An active papule, pustule or nodule, by contrast, is an inflammatory lesion that continues to evolve. Treating an area with numerous active lesions can therefore complicate recovery.
Assessment before scar treatment therefore concerns more than scar type and depth alone. It must also determine whether the acne responsible for these scars is still active.
Can some scars be treated while a few spots remain ?
Yes. A few isolated spots do not necessarily prevent acne scar treatment if inflammatory breakouts are generally controlled.
The situation is different when numerous inflammatory spots continue to appear. In this case, acne must be treated first because new scars may still form.
The location of the spots is also important. An area with active inflammatory lesions may require waiting for them to disappear, while another area containing only scars may potentially be treated.
It is therefore not necessary to wait for every spot to disappear. What matters is that inflammatory acne is sufficiently stabilised before scar treatment begins.
Can laser scar treatment be performed during an acne breakout ?
Generally, no. Laser treatment intended for acne scars is performed once the inflammatory breakout is controlled. It treats existing scars rather than active spots.
Fractional lasers used for atrophic scars create microscopic treatment zones to stimulate collagen production and remodelling. They are not intended to treat the papules, pustules or nodules of an acne breakout.
Some lasers can be used to treat active acne, but their aim is different. They act on acne that is still developing, whereas lasers intended for scars seek to improve the marks left by previous lesions.
Laser treatment of active acne must therefore be distinguished from laser scar treatment. During an inflammatory breakout, the priority is to control the acne before treating scars.
Can scar treatment begin during isotretinoin treatment ?
Yes. Some acne scar treatments can be performed while taking isotretinoin. It is no longer necessary to routinely wait six to twelve months after stopping treatment.
This waiting period was previously recommended because of concerns about poor healing or abnormal scar formation. More recent studies no longer justify this precaution for every procedure.
In particular, certain fractional lasers, ablative or non-ablative, may be used during isotretinoin treatment in selected patients.
Nevertheless, the possibility of treating scars must be assessed individually. The choice depends on the laser used, its intensity, the isotretinoin dose and the condition of the skin.
It is also necessary to check that acne is sufficiently controlled. If numerous inflammatory lesions are still present, it is preferable to treat active acne first before starting scar treatment.
When can scar treatment begin after an acne breakout ?
Scar treatment can begin when inflammatory acne is sufficiently controlled and the lesions left by previous breakouts are stabilised. There is no fixed waiting period after the last spot.
It is therefore not necessary to routinely wait three, six or twelve months. The main criterion is the absence of regular new inflammatory breakouts likely to cause new scars.
A true scar must also be distinguished from a recent mark left by a spot. After an inflammatory lesion, redness or a pigmented mark may persist without necessarily being a permanent scar. It is therefore necessary to wait until the lesion has healed completely before assessing any scar left by the spot.
Treatment can therefore be considered when acne is controlled and the scars to be corrected are clearly identifiable and stabilised.
What can be done about existing scars while acne is still active ?
When acne is still active, the priority is to treat it to limit new scar formation. However, existing scars can be examined and classified to anticipate the treatment that may be offered once acne is controlled.
This assessment also distinguishes true scars from the red or pigmented marks left by spots, which may still fade spontaneously.
Acne treatment is adapted to its form and severity. Current recommendations include topical retinoids, benzoyl peroxide, certain antibiotics and isotretinoin when indicated.
Article written by Dr Valeria Romano
Dr Valeria Romano supports each patient with a comprehensive approach to the aesthetics of the face, body and intimate areas, and to skin and hair quality. Every treatment is based on a personalised medical assessment.
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