Why Effective Treatment Must Address Both the Internal and External Scars of Acne

In a continuing conversation, Suneel Chilukuri, MD, of Refresh Dermatology in Houston, Texas, emphasized that successful acne management extends beyond treating active lesions and should also address the long-term physical and psychological effects of the disease. According to Chilukuri, patients often focus on the visible blemish present during an office visit, while overlooking the potential for permanent scarring and the significant impact acne can have on self-confidence and emotional well-being.

Chilukuri noted that even a single prominent lesion can affect how patients perceive themselves and interact socially. As a result, acne treatment should be viewed through a broader lens that includes both prevention of future scarring and preservation of quality of life. He encouraged clinicians to discuss these concerns proactively with patients, particularly during Acne Awareness Month, when education and early intervention are key themes.

“What we're not always paying attention to is not just the scarring that's visible physically, [but] also the internal scarring, the mental scarring,” he reminded.

To help reduce inflammation and minimize the risk of post-acne sequelae, Chilukuri highlighted the value of accessible topical therapies. Salicylic acid remains an important over-the-counter option because of its anti-inflammatory properties and ability to help clear pores. He also discussed the role of topical retinoids, particularly adapalene, which is now widely available without a prescription. By increasing cellular turnover from approximately every 38 to 42 days to every 7 to 10 days, adapalene can help reduce acne lesions while also improving post-inflammatory erythema and decreasing the likelihood of long-term scarring. This combination of prevention and treatment, he said, supports a more holistic approach to acne care.

The discussion also explored advances in microneedling for acne scars. Chilukuri reflected on the evolution of collagen induction therapy since its early development in the 1990s and highlighted the importance of evidence-based technology. He noted that SkinPen became the first FDA-cleared microneedling device after nearly a decade of clinical development and regulatory review. In his practice, SkinPen remains a preferred option because of its active needle retraction mechanism and powerful motor system, which allow for smoother treatment of acne scars, thicker skin, and keloidal tissue while minimizing trauma and discomfort.

Finally, Chilukuri cautioned patients against relying solely on social media skincare advice. While digital platforms can provide education, he stressed the importance of evaluating the credibility of sources and seeking guidance from qualified acne experts. As misinformation continues to circulate online, dermatologists play a critical role in helping patients distinguish evidence-based recommendations from trends that may ultimately worsen acne or compromise skin health.

“What we're finding now with social media…it's a great avenue for learning and putting some information out there, but you have to make sure that it's vetted information and make sure that it's actually accurate,” Chilukuri concluded.