Treating Pigmentation Secondary to Acne and Rosacea
Before you run and commit yourself to laser treatments, I would try some aggressive topical skin lightening options. Topical RetinA (tretinoin) definitely helps to improve more quickly the pigmentation. Hydroquinone (a bleaching agent) can also be used for spot treatment. There are other skin lightening options including glycolic, kojic acid, and Lumixyl to name a few. I would also recommend considering a series of superficial chemical peels (ie. glycolic acid) after having used the topical lightening agents for a good 3-4 months.
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Micro needling can help acne rosacea scarring
If you're fearful of getting laser treatments done then micro needling is an excellent option for you. There is minimal downtime with minimal to no negative side effects. If your scars have a red undertone then IPL (intense pulsed light) may also be a great option to even out the skin.
Red Marks from Cystic Acne
The best treatment for the redness from cystic acne is the V-Beam laser. It will take several treatments one month apart to achieve the best cosmetic results. If any of the acne scars are brown or hyper pigmented, you would also benefit from a mild hydroquinone and some light peels. I would avoid Retin-A to any red scars as the Retin-A may make is more red and irritated. Deep acne scars benefit from the Fraxel (1550) laser. Please find a Board certified dermatologist with a great deal of experience in cosmetic lasers for the best results.