17-Year-Old Female Experiencing Chronic Acne Scarring on Back and Arms Despite Prescription Remedies
Age: 17 Gender: Female Country of residence: United Kingdom Skin type: Dark / Black Medical background: No significant health issues Medications: Previously utilized azelaic acid and benzoyl peroxide Timeframe: Many months to years following acne resolution Greetings, I am a 17-year-old girl dealing with long-lasting scars on my back and upper arms from acne, which have not improved even after following prescribed treatments. In the past, I experienced acne primarily on my upper back, shoulders, and arms. While the active breakouts have largely ceased, I am left with noticeable dark spots and irregular skin texture. The scars I have include: • Dark brown hyperpigmentation • Certain areas appear slightly sunken • Uneven or coarse surface • No raised or keloid scars present My GP prescribed azelaic acid and benzoyl peroxide, which I applied regularly. Unfortunately, the azelaic acid did not significantly lighten the scars and seemed inadequate for the pigmentation level. Although benzoyl peroxide was effective against my active acne, it did not enhance the appearance of the scarring. The marks have been present for a considerable time and are quite stark against my skin tone. I do my best to avoid picking at my skin and maintain proper hygiene, yet the scars aren’t diminishing on their own, which is negatively impacting my self-esteem—especially when I wear sleeveless or backless outfits. Currently, I'm exploring the possibility of using retinoids like adapalene or tretinoin. However, I’m uncertain if these would be suitable or effective for treating scarring on my back and arms, particularly with my darker skin type. I would like guidance on the following questions: • Does this seem to be primarily post-inflammatory hyperpigmentation, atrophic acne scars, or possibly a combination of both? • Is azelaic acid effective for this type of scarring, or are more potent treatments generally required? • Are topical retinoids such as adapalene or tretinoin advisable for this sort of scarring? • What treatments are typically recommended for acne scars on the back and arms in individuals with darker skin tones? • Should I insist on a referral to a dermatologist, or is it better to attempt specific topical therapies first? Any insights or recommendations you could offer would be greatly appreciated.
Answers (1)
2/7/2026, 12:30:35 PM
OpenHealth AI
It sounds like you're feeling frustrated with the persistent scars from your past acne, especially since they are affecting your self-esteem. The journey toward clearer skin can be challenging, particularly with darker skin tones, but there are effective approaches available. Let's address your specific concerns one at a time.
Main Points:
- Your scars are likely a combination of post-inflammatory hyperpigmentation and atrophic scars.
- Azelaic acid may not be sufficient for deeper scars; stronger treatments could help.
- Topical retinoids are generally beneficial for scarring.
- A referral to a dermatologist could be advantageous if over-the-counter treatments don't bring improvement.
Explanation:
- Scarring Types:
- Post-Inflammatory Hyperpigmentation (PIH) appears as dark spots and is caused by inflammation. This is common in darker skin tones.
- Atrophic Scars are the sunken areas you mentioned, often resulting from loss of collagen.
This dual presence is not unusual, and both types can occur after acne.
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Azelaic Acid: While this is a helpful treatment for acne and can improve hyperpigmentation, it may not be strong enough for established deeper scars, especially if you're looking for noticeable results.
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Topical Retinoids:
- Adapalene and Tretinoin can promote cell turnover, enhance collagen production, and improve skin texture over time. They are generally safe for darker skin, but you should start with caution and monitor your skin's reaction, especially since retinoids can initially cause irritation.
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Treatment Recommendations for Dark Skin Types:
- Apart from retinoids, consider products containing Vitamin C (for brightening), or chemical exfoliants like glycolic or lactic acid, as these can help with hyperpigmentation and texture.
- For more severe scarring, treatments like chemical peels or laser therapy may be suggested by a dermatologist, but this would depend on your skin's specific needs.
Next Steps:
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Start with a Retinoid: Consider incorporating a topical retinoid like adapalene (available over-the-counter) into your nighttime routine. Use it 2-3 times a week initially to gauge your skin's tolerance.
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Use Sun Protection: Daily use of sunscreen is critical to prevent further darkening of the scars. Look for a broad-spectrum SPF 30 or higher.
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Monitor Your Skin: Keep track of any changes in your scars over the next 8-12 weeks while using these treatments. If you notice any improvement or irritation, adjust usage based on your observations.
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Dermatology Referral: If you don’t see significant improvements after this period, or if you have concerns about your current products, consider asking your GP for a referral to a dermatologist. A specialist can provide tailored treatments and possibly more effective combinations or procedures.
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Support & Confidence: Remember that your skin's journey is unique, and it's okay to seek help. Consider talking to someone about how you're feeling; self-esteem can be nurtured through positive conversations and support.
Feel free to update me on your progress or if you have more questions!
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