I would start with a Dermatologist to get your actice acne under control with retinoids and glycolics. PDT with blue light has been successful in our office for hard to treat cases. Once the active acne is better, fractional lasers, IPL and fractionated RF has been useful for our patients. Occasionally long term fillers such as Bellafill can help as well. Hope that is helpful.
Treat acne with isotretionin to get rid of it completely. In the mean time, glycolic washes and salicylic acid body sprays help. Once improved, scarring can be treated with a combination approach of lasers (Fractional Laser Resurfacing), peels, skin care and microneedling and fillers. I suggest consulting with an experienced cosmetic dermatologist. Best, Dr. Emer
Acne scars are treated differently depending on their appearance and structure. Sometimes there is no actual scar at all, but just a dark spot from inflammation. These spots usually improve on their own if you protect them and keep them out of the sun. In the meantime, to control the inflammation and acne breakouts, topical retin-a cream with intermittent salicylic acid peels can dramatically improve your skin tone and frequency of breakouts. Once the acne is controlled and you continue to do have remaining scars due to permanent dermal injury from acne, a variety of treatments can be performed to remodel the scar from energy-based lasers and radiofrequency devices to mechanical disruption of the scar with microneedling. Deep wide scars can be released and filled in with subcision and fillers and ice-pick (thin, deep) scars are best treated by excising them completely. For the best treatment options, it is important to visit an expert for an in-person examination. Hope this helps!
Johnson C. Lee MD
The pictures still show active acne which needs to be treated first. Once the acne is under control, then any underlying scars could be addressed. It would be best to evaluate your skin in person to make an individualized treatment plan. I would recommend that you see a dermatologist who has experience treating both acne and acne scars.
The very most important thing first step is to get the acne under control. It is not likely in my opinion that the birth control pill, though helpful, will sufficiently control cystic acne. Consider discussing a course of Accutane with a dermatologist (usually 6 months). Ice pick scars are very difficult to treat so get control now before you get more. Once the acne is fully controlled, and fater waiting until you have been off Accutane for 6 months, you can be treated perhaps with dermabrasion, microneedling, possibly laser- the remodel scar collagen.
Lisa Vuich, MD
Thank you for sharing your photos. I am sorry you are suffering from acne as it is a frustrating condition that flares with stress. From the pictures it appears you are still having active acne flares in addition to some acne scarring. There are multiple treatments for acne including over the counter topical benzoyl peroxide creams and washes (Clearasil, Neutrogena, etc.) that will help reduce the bacteria that is one of the contributing factors. If possible, please also see a dermatologist to start on a tretinoin (Retin-A) product that will help control the production and shedding of your skin. You may also consider using a machine like Theraclear that will help improve acne in 24-48 hours. Please try to not "pick" at the acne as it will increase the chance of scarring.
Once your acne is controlled, you can consider options to improve the scarring. There are many low cost procedures including medical grade microneedling, radiofrequency microneedling (Vivace, Infini, etc.), lasers, Sculptra, and Bellafill. Most often we use a combination of treatments to provide the best results. Please seek an expert who has significant experience in treating acne scars.
Best of luck,
Suneel Chilukuri, M.D.
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Often times laser treatments combined with a good acne regimen is beneficial and very effective. Spot treatments with laser often times decreases healing time and reduces recurrence. Other treatments such as Laser Genesis can help with scarring, redness, fine lines, wrinkles and pores -- and are a series of treatments. From your pictures a combination treatment or a start with medication would be reasonable. Either way, you will need medication/acne treatment. Good luck!