What are the recommended topical treatments for acne scarring?

Topical Treatments for Acne Scarring

Adapalene is the recommended first-line topical treatment for acne scarring due to its efficacy in improving acne sequelae with better tolerability than other retinoids. 1, 2

Retinoid Options for Acne Scarring

Topical retinoids are the cornerstone of acne scar treatment due to their ability to:

• Promote collagen production
• Enhance cell turnover
• Reduce hyperpigmentation
• Improve overall skin texture

Recommended Retinoid Options (in order of preference):

1. Adapalene (0.1% or 0.3%)

   • Best tolerability profile among retinoids 1, 3
   • Comparable efficacy to tretinoin but with fewer side effects
   • Available over-the-counter (0.1%) or prescription (0.3%)
   • Apply once daily in the evening

2. Tretinoin (0.025% - 0.1%)

   • Effective but with higher irritation potential 4, 3
   • Available in multiple formulations (cream, gel, microsphere)
   • Apply once daily in the evening after face is completely dry (wait 20-30 minutes after washing) 4

3. Trifarotene (0.005% cream)

   • Newer retinoid showing promising results for acne scarring
   • Demonstrated 55.2% reduction in atrophic acne scar count at 24 weeks 2
   • Particularly effective for patients at risk of atrophic scarring

Application Techniques to Improve Tolerability

1. Standard Application Therapy (SAT)

   • Apply a thin film to affected areas once daily before bedtime
   • Use only a pea-sized amount for the entire face

2. Short Contact Therapy (SCT)

   • Apply product for 30-60 minutes then wash off with gentle cleanser
   • Significantly better tolerability while maintaining efficacy 5
   • Recommended for patients with sensitive skin or those experiencing irritation

Combination Approaches

For enhanced results, consider combining retinoids with:

• Glycolic acid (4-10%): Enhances exfoliation and improves penetration of retinoids 5
• Niacinamide: Helps with hyperpigmentation, especially for darker skin tones 1
• Azelaic acid: Addresses post-inflammatory hyperpigmentation 1
• Hyaluronic acid: Helps maintain hydration when using retinoids 1

Managing Side Effects

Common side effects include:

• Erythema
• Dryness
• Scaling
• Stinging/burning

Management strategies:

• Start with lower concentrations (e.g., adapalene 0.1% instead of 0.3%)
• Begin with application every other night, gradually increasing to nightly use
• Apply moisturizer before or after retinoid application
• Use gentle, non-medicated cleansers
• Apply sunscreen daily (SPF 30+) as retinoids increase photosensitivity 1, 4

Special Considerations

• For darker skin tones: Combine retinoids with ingredients that address hyperpigmentation (niacinamide, azelaic acid) 1
• For sensitive skin: Start with adapalene 0.1% (most tolerable retinoid) or use short contact therapy 1, 5
• For mature skin: Add hyaluronic acid and peptides to enhance anti-aging effects 1
• For maintenance: Continue retinoid use even after improvement to prevent recurrence 1, 6

Cautions and Contraindications

• Avoid use during pregnancy (especially tretinoin - Pregnancy Category C) 4
• Unknown if excreted in breast milk; use caution in nursing mothers 4
• Avoid application near eyes, mouth corners, and open wounds 4
• Do not use with other potentially irritating products (alcohol-based products, medicated soaps) 4

Topical retinoids should be initiated early in acne treatment to prevent scarring, as they are more effective at preventing scar formation than treating established scars 2, 6.