Tan and colleagues showed that 43% of 1942 patients with SOC and acne had acne-related scarring and that most acne scars (99%) originated from inflammatory and post-inflammatory acne lesions.35
The clinician should inform the patient and parents about PIH and acne-related scarring to help them understand why they occurred.9,37 Both the patient and the parents were educated on acne-related PIH, and a handout on acne and PIH was given. The 15-year-old girl initially received prescription therapy with topical tretinoin, which had worsened her PIH. The treatment was changed to prescription therapy with 20% azelaic acid cream after discontinuing the generic tretinoin. Adjunctive skin care was recommended with ceramide-containing 4% BPO foaming wash, facial moisturizing lotion in the morning, and ceramide-containing facial moisturizing lotion in the evening.
The patient was counseled to avoid abrasive scrubs, rubbing the skin, and topical alcohol, which leads to irritation and thus inflammation.9,37,38 Gentle skin care, decreasing washing, increasing moisturizer, and sunscreen use are beneficial for richly pigmented skin.5,6,9,37,38
Takeaways/clinical pearls: The concern for PIH should be addressed; education of patients with PIH takes significantly longer than other acne patients; a handout on PIH that
