I have acne scars despite medications. What else can help me?

Question

Hello doctor,

I am a 25-year-old female seeking to confirm if the scars on my chin may be hypertrophic papular scarring, and if so, what treatments would be recommended?

I have several small, flesh colored raised scars on your chin that developed after inflamed acne, and they have persisted for a couple of years. They are slightly lighter than my normal skin and do not itch or hurt.

I made the mistake of trying a plasma pen a couple of months ago, which made them lighter than my original skin tone but did not flatten them. I have tried at-home treatments like Silicone scar gel, Tretinoin application, AHA/BHA exfoliants, and nothing has improved. Currently not on any medications.

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Thank you so much for sharing your detailed history and photos (the attachments were removed to protect the patient's identity). I truly understand how frustrating it can be to deal with persistent raised scars, especially on the chin, where they are so visible.

It is completely valid that this has been bothering you, particularly after trying multiple treatments without improvement.

Based on your description and attached picture, I can see small, flesh-colored to slightly lighter, raised papules that developed after inflamed acne and have remained stable for over two years.

These are very consistent with hypertrophic papular acne scars. These differ from keloids in that they remain confined to the original acne lesion area and do not continue expanding beyond the borders.

The fact that they are not itchy, painful, or progressively enlarging also supports hypertrophic scarring rather than active keloid formation.

The lightening you noticed after the plasma pen is likely due to post-inflammatory hypopigmentation or mild thermal injury from the procedure. Plasma devices can sometimes alter pigment without significantly remodeling deeper scar tissue, which is why the scars became lighter but did not flatten.

Regarding treatment, at-home therapies such as Silicone gel, Tretinoin, and AHA (alpha hydroxy acid ) or BHA (beta hydroxy acid) exfoliants are generally helpful for texture irregularities and pigmentation, but are unfortunately not strong enough to significantly reduce established hypertrophic scars that have been present for years.

The most effective treatment options are procedures in your case and should be performed by an experienced dermatologist. I am giving you a few options which you can choose according to the availability in your area, but they should be done only by an expert.

Intralesional corticosteroid injections (for example, Triamcinolone). This is a first-line treatment. Small amounts are injected directly into the scar to reduce collagen overproduction and flatten the lesion gradually. Multiple sessions (usually spaced four to six weeks apart) may be required.
Cryotherapy (carefully applied) can reduce hypertrophic tissue, but must be done cautiously on the chin to avoid further hypopigmentation, especially since your scars are already lighter.
Carbon dioxide (CO2) laser ablation or fractional laser resurfacing helps remodel collagen and smooth raised scars, but should only be done by an experienced laser specialist, as overtreatment can worsen pigment changes.
Radiofrequency microneedling may improve texture and stimulate controlled remodeling, though results vary with hypertrophic scars. Among these, I would suggest you go for a CO2 (carbon dioxide) laser for better cosmetic results.

I hope this helps.

Let me know if you have any more questions. I would be happy to help you.

Thank you.