How to manage post-treatment scars in a 19-year-old?

Question

Hello doctor,

I am 19 years old, and I had an issue with subcutaneous fat and pustules. I started treatment with a doctor about one and a half months ago. He prescribed Acretin 0.05 percent and Garmisin to be used daily, along with Azrolid tablets, which I take for four days and then stop for three days.

The subcutaneous fat has reduced significantly and has almost disappeared, and the pustules are nearly gone. However, I am left with severe marks, not only pits but visible scars as well.

The doctor advised me to continue the treatment without using a moisturizer. I would like to know what the fastest solution is to treat these marks. Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com

Thank you for explaining your situation so clearly. I understand how upsetting it can be to see active acne improve while being left with prominent marks and texture changes, especially at such a young age.

Based on your description, you initially had inflammatory acne with deep involvement, including subcutaneous nodules and pustules (pus-filled acne lesions).

The treatment you were prescribed includes Tretinoin (Acretin 0.05 percent, a topical retinoid that increases skin cell turnover and stimulates collagen production), topical Gentamicin (Garmisin, an antibiotic that reduces bacterial infection), and oral Azithromycin (Azrolid given in pulse dosing, an antibiotic taken intermittently to control acne-causing bacteria and inflammation). This is a commonly used regimen to reduce bacterial load, control inflammation, and normalize skin renewal.

The marks you are experiencing are most likely a combination of post-inflammatory hyperpigmentation (dark spots left after acne heals), persistent redness, and early acne scarring (permanent changes in skin texture caused by collagen damage).

Regarding moisturizers, some doctors temporarily restrict their use during very oily or actively infected acne phases. However, current dermatological evidence strongly supports the use of a non-comedogenic moisturizer (a moisturizer that does not block pores) alongside topical retinoids like Tretinoin. Products such as Physiogel AI are commonly prescribed with Tretinoin, including in my own patients, and can be used safely to maintain the skin barrier and reduce irritation.

To manage your scars, it is important to continue using Tretinoin consistently, as it is scientifically proven to stimulate collagen production, improve skin texture, and gradually fade marks over time. Noticeable improvement in marks typically begins after eight to twelve weeks, with continued improvement over several months.

For faster visible improvement, you may use 20 % azelaic acid cream (a topical medication that reduces pigmentation, inflammation, and acne bacteria) at bedtime twice a week. On those two days, skip the application of topical Tretinoin, as using both together can increase dryness and irritation. Azelaic acid helps improve pigmentation and early scar marks.

Once your acne is completely controlled, procedural treatments such as chemical peels (controlled chemical exfoliation to improve skin tone and texture) or microneedling (a procedure that stimulates collagen by creating tiny skin injuries) can be considered to treat scars more quickly and effectively.

I hope this explanation has addressed your concerns.

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Thank you.