ACNE SCAR SUMMIT 2025: ERASE THE TRACE Innovations and Multimodal Strategies in Acne Scar Management
14 Nov 2025
In pursuit of improving patient’s lives affected by acne and acne scarring, Galderma Philippines gathered Board-certified Dermatologists to discuss interventions and rising innovations in its management through the Acne Scar Summit 2025.
The Symphony of Strategy: Acne Scars Solutions
“Acne management is like a symphony—we are the conductors,” began Dr Nadela, as she painted a vivid analogy of the therapeutic journey. With nearly 47% of acne patients developing scars, she emphasized a triad of foundational strategies: early control of active acne, use of topical retinoids, and appropriate procedural interventions.1
Acne scars are classified into hypertrophic, keloidal, papular, and atrophic types, with atrophic scars (icepick, rolling, and boxcar) comprising 80–90% of cases (Figure 1).2,3 Evidence shows that treatment is tailored to scar morphology (table 1). While ablative lasers are effective, they pose risks for skin of color. Safer alternatives like non-ablative fractional lasers and radiofrequency microneedling (RF MN) offer comparable benefits with lower risk of post-inflammatory hyperpigmentation (PIH).4-7
CROSS chemical reconstruction of skin scars; a Modalities with substantial quality of evidence data are included; b Used as adjunct to other procedures
Combination therapy over monotherapy yields better outcomes, citing evidence that pairing modalities like TCA CROSS, subcision, fillers, or microneedling with energy-based devices enhances outcomes. Microneedling with chemical peels, for instance, has been shown to outperform either technique used alone. Patients on isotretinoin can still undergo selected procedures—non-ablative lasers and superficial peels are now considered safe, per updated American Society of Dermatologic Society guidelines.8,9
Dr Nadela emphasized the value of synergistic combinations, noting also that acne must first be well-controlled before initiating procedural treatments. Topical retinoids can be continued during the procedural phase to boost results, although multiple sessions are usually necessary. Importantly, patients must be educated to expect improvement—not total clearance—and to view their treatment as a personalized, holistic journey toward skin recovery.
All Angles Covered: Treating Every Type of Acne Scars – Insights from Taiwan
Dr Chuang Ying Yan shared her clinical experience in integrating retinoids across the acne spectrum—from active inflammation to post-acne scarring.
Acne pathogenesis involves four major mechanisms: inflammation, hyperkeratinization, excess sebum, and Propionibacterium acnes colonization. Retinoids uniquely target three of these, making them the foundation for both acne and post-acne care.10,11
She reviewed topical options by molecule and concentration (table 2), cautioning that overly conservative dosing can hinder efficacy and adherence, while overly aggressive use risks side effects like erythema and peeling. In her experience, adapalene and trifarotene are better tolerated than tretinoin, allowing for more sustained use. A minimum of six weeks is ideal, with reassurance that irritation typically subsides within one to two months.
Once acne is controlled, scars must be addressed. For non-permanent scarring, she integrates retinoids with pigment-correcting agents such as hydroquinone, arbutin, kojic acid, vitamin C, azelaic acid, and niacinamide. She also highlights ivermectin 1% (Soolantra) for patients with demodicosis, which she notes is present in roughly 80% of her practice. Procedures like chemical peels and non-ablative or picosecond lasers further enhance outcomes.
For permanent scars, she advocates early intervention with energy-based devices, followed by retinoids to support healing, prevent PIH, and maintain momentum in treatment. Continued retinoid use also reinforces adherence, as patients perceive ongoing improvement.
Dr Chuang Ying Yan closed with five takeaways: set expectations early, maintain consistent use of retinoids, rotate formulations for better tolerability, enhance results with complementary treatments, and ensure all acne scar patients remain on retinoids to sustain efficacy.
The Lingering Marks f Acne: Updates on Managing Erythema and Hyperpigmentation
Acne doesn’t end with the lesions—it often leaves behind visible marks in the form of macular erythema and hyperpigmentation. Dr Handog highlighted the importance of early, targeted intervention in these transitional lesions to prevent progression to permanent scarring.
Acne-induced macular erythema (AIME) and acne-induced macular hyperpigmentation (AIMH) are transitional lesions that can lead to atrophic scars. AIME is a sign of ongoing inflammation, which either persists or culminates to atrophic scarring, while AIMH is a post-inflammatory condition. Of these, AIME is more severe.12,13
AIME treatment has no gold standard treatment. Topicals such as tranexamic acid, oxymetazoline, or timolol may be used, while procedures like pulsed dye laser, IPL, and microneedling RF offer more targeted results. For AIMH, therapy focuses on disrupting melanin production. Retinoids are central to this approach, with trifarotene showing promise in reducing both pigmentation and atrophic scars (figure 2).14-17
Figure 2. Mean absolute change from baseline in total atrophic acne scar counts.17 P values refer to the Student’s ttest for paired samples performed on the intra-subject difference between trifarotene 50 lg/g and vehicle at each analysis visit. *0.01 < P value < 0.05; **0.001 < P value < 0.01; ***0.0001 < P value < 0.001; ****P value< 0.0001
In a six-month study, the combination of trifarotene with a supportive skincare regimen and sun protection resulted in significant improvement in post-AV hyperpigmentation index and overall disease severity scores between weeks 12 and 24, with high levels of patient satisfaction and adherence to treatment.18
Emphasis was given on early acne control using retinoids and benzoyl peroxide to prevent new lesions, minimize pigmentation, and reduce scarring risk. Patient education is key—AIMH may fade slowly, but adherence and photoprotection speed resolution.19
Dr Handog also emphasized that acne scar treatment is a multi-step process, beginning with careful evaluation and classification of the scars, identifying the patient’s primary concern, and selecting appropriate procedures to target different components of the scarring process. She reiterated setting realistic expectations—that acne scars can be improved, but not completely erased.
Beyond the Surface: Topical and Procedural Synergy in Acne Scar Treatment
Dr Adraneda discussed four clinical cases to illustrate the synergy between topical and procedural interventions.
One involved a 52-year-old woman whose scars worsened with aging skin. Despite previous laser sessions, visible improvement was achieved through RF microneedling, subcision, PLLA, and skin boosters. Trifarotene was introduced on day four post-procedure, alongside antioxidants and sun protection.
Another patient, a 25-year-old with deep boxcar and rolling scars resistant to CO₂ lasers, received a combination of RF microneedling, TCA CROSS, subcision, CO₂ laser, PLLA-SCA, and exosomes. Significant scar improvement was noted within a month, with trifarotene aiding in post-treatment remodeling.
A third case featured a 24-year-old with mixed scars and erythema treated using TCA CROSS, CO₂ laser, hyaluronic acid, and exosomes. Trifarotene initiated on day five supported pore refinement and erythema reduction.
Lastly, a 22-year-old male showed marked improvement in texture and scar depth after a similar multimodal regimen. Mild PIH was addressed with ongoing trifarotene use.
Dr Adraneda emphasized that effective scar treatment requires individualized strategies, combining targeted procedures with post-treatment retinoids to enhance collagen remodeling and support long-term results. Photoprotection and barrier care are essential, along with managing patient expectations to ensure satisfaction and adherence.
Red Alert: Multimodal Strategies for Acne-Related Erythema, Discoloration and Depression
Dr Valencia showcased the importance of early inflammation control and tailored combination therapies in managing post-acne erythema, hyperpigmentation (PIH), and scarring through four patient cases.
A 22-year-old male with post-acne erythema and atrophic scars was treated with a regimen of topical tranexamic acid, vitamin C, and adapalene/benzoyl peroxide. Alternating azelaic acid peels and quasi long-pulsed Nd:YAG laser sessions significantly reduced erythema by week 12, with no adverse events.
In a 24-year-old female with active acne and PIH, treatment combined clindamycin, azelaic acid, and trifarotene, plus Q-switched Nd:YAG laser. By week 8, pigmentation and acne lesions had resolved. Trifarotene’s anti-inflammatory and keratinocyte turnover properties were key to her rapid improvement.
The next two cases involved atrophic scarring. A 28-year-old male unable to commit to regular procedures underwent a single-visit combination treatment with fractional CO₂ laser, TCA CROSS, and subcision, supported by topical adapalene, azelaic acid, and vitamin C. After six months, notable scar shallowing and improved texture were observed.
Similarly, a 42-year-old female with limited follow-up access showed moderate improvement in rolling scars and PIH over four months solely on a combination of topical medications.
Dr Valencia concluded that prevention starts with controlling inflammation. Combining multifunctional topicals like retinoids with tailored procedures remains central in addressing acne-related erythema, discoloration, and scarring, especially in patients with diverse treatment needs and constraints.
Glow On: Combination Injectable Treatments for Acne Scar
Acne vulgaris affects 85% of adolescents worldwide, with 95% developing scarring, mostly atrophic and characterized by tissue loss. Improving skin quality is key to restoring self-confidence. Dr Puyat highlighted the role of dermal fillers in managing these scars, focusing on non-animal stabilized hyaluronic acid (NASHA; Restylane™ Skin Boosters) and Poly-L-lactic acid (PLLA; Sculptra®).20,21
Cross-linked NASHA not only provides volume but also stimulates collagen production by activating growth factors, inhibiting collagen breakdown, and stretching fibroblasts. Available in two formulations—20 mg/ml NASHA (Restylane Vital) and 12mg/ml NASHA (Restylane Vital Light)—the former is preferred for acne scars. Its unique delivery system allows precise microdroplet injections for targeted treatment. 20,21
PLLA, is a semi-permanent filler approved for soft tissue augmentation. It improves volume loss by stimulating fibroblasts to produce collagen gradually.21
Injectable fillers are best suited for boxcar and rolling type of acne scar. During the discussion, Dr Puyat also presented her technique utilizing both NASHA and PLLA.
Dr Puyat emphasized a tailored, multimodal approach combining these injectables with other cosmetic procedures to maximize outcomes. While single treatments can improve scars, combining multiple sessions of NASHA-based boosters and PLLA enhances collagen remodeling and skin texture, offering progressive, synergistic reduction of acne scars—especially rolling and boxcar types.
This integrative strategy addresses both volume loss and skin quality, providing patients with lasting improvements and renewed confidence.
From Inflammation to Renewal
The lectures presented a rich, multifaceted exploration of acne and its sequelae, highlighting advances in topical therapies, procedural innovations, and combination treatments. Experts discussed personalized, multimodal approaches—integrating retinoids, lasers, chemical peels, and injectable fillers—to effectively address acne lesions, erythema, hyperpigmentation, and diverse scar types. Prevention, patient education, and realistic goal-setting were emphasized as vital to optimizing outcomes.
Committed to advancing dermatological education, Galderma takes pride in hosting impactful scientific events that deliver valuable insights from leading experts. By actively supporting healthcare professionals with timely, relevant, and scientifically accurate information, the company fosters improved patient care and drives ongoing progress in dermatology.
The Symphony of Strategy: Acne Scars Solutions
“Acne management is like a symphony—we are the conductors,” began Dr Nadela, as she painted a vivid analogy of the therapeutic journey. With nearly 47% of acne patients developing scars, she emphasized a triad of foundational strategies: early control of active acne, use of topical retinoids, and appropriate procedural interventions.1
Acne scars are classified into hypertrophic, keloidal, papular, and atrophic types, with atrophic scars (icepick, rolling, and boxcar) comprising 80–90% of cases (Figure 1).2,3 Evidence shows that treatment is tailored to scar morphology (table 1). While ablative lasers are effective, they pose risks for skin of color. Safer alternatives like non-ablative fractional lasers and radiofrequency microneedling (RF MN) offer comparable benefits with lower risk of post-inflammatory hyperpigmentation (PIH).4-7
CROSS chemical reconstruction of skin scars; a Modalities with substantial quality of evidence data are included; b Used as adjunct to other procedures
Combination therapy over monotherapy yields better outcomes, citing evidence that pairing modalities like TCA CROSS, subcision, fillers, or microneedling with energy-based devices enhances outcomes. Microneedling with chemical peels, for instance, has been shown to outperform either technique used alone. Patients on isotretinoin can still undergo selected procedures—non-ablative lasers and superficial peels are now considered safe, per updated American Society of Dermatologic Society guidelines.8,9
Dr Nadela emphasized the value of synergistic combinations, noting also that acne must first be well-controlled before initiating procedural treatments. Topical retinoids can be continued during the procedural phase to boost results, although multiple sessions are usually necessary. Importantly, patients must be educated to expect improvement—not total clearance—and to view their treatment as a personalized, holistic journey toward skin recovery.
All Angles Covered: Treating Every Type of Acne Scars – Insights from Taiwan
Dr Chuang Ying Yan shared her clinical experience in integrating retinoids across the acne spectrum—from active inflammation to post-acne scarring.
Acne pathogenesis involves four major mechanisms: inflammation, hyperkeratinization, excess sebum, and Propionibacterium acnes colonization. Retinoids uniquely target three of these, making them the foundation for both acne and post-acne care.10,11
She reviewed topical options by molecule and concentration (table 2), cautioning that overly conservative dosing can hinder efficacy and adherence, while overly aggressive use risks side effects like erythema and peeling. In her experience, adapalene and trifarotene are better tolerated than tretinoin, allowing for more sustained use. A minimum of six weeks is ideal, with reassurance that irritation typically subsides within one to two months.
Once acne is controlled, scars must be addressed. For non-permanent scarring, she integrates retinoids with pigment-correcting agents such as hydroquinone, arbutin, kojic acid, vitamin C, azelaic acid, and niacinamide. She also highlights ivermectin 1% (Soolantra) for patients with demodicosis, which she notes is present in roughly 80% of her practice. Procedures like chemical peels and non-ablative or picosecond lasers further enhance outcomes.
For permanent scars, she advocates early intervention with energy-based devices, followed by retinoids to support healing, prevent PIH, and maintain momentum in treatment. Continued retinoid use also reinforces adherence, as patients perceive ongoing improvement.
Dr Chuang Ying Yan closed with five takeaways: set expectations early, maintain consistent use of retinoids, rotate formulations for better tolerability, enhance results with complementary treatments, and ensure all acne scar patients remain on retinoids to sustain efficacy.
The Lingering Marks f Acne: Updates on Managing Erythema and Hyperpigmentation
Acne doesn’t end with the lesions—it often leaves behind visible marks in the form of macular erythema and hyperpigmentation. Dr Handog highlighted the importance of early, targeted intervention in these transitional lesions to prevent progression to permanent scarring.
Acne-induced macular erythema (AIME) and acne-induced macular hyperpigmentation (AIMH) are transitional lesions that can lead to atrophic scars. AIME is a sign of ongoing inflammation, which either persists or culminates to atrophic scarring, while AIMH is a post-inflammatory condition. Of these, AIME is more severe.12,13
AIME treatment has no gold standard treatment. Topicals such as tranexamic acid, oxymetazoline, or timolol may be used, while procedures like pulsed dye laser, IPL, and microneedling RF offer more targeted results. For AIMH, therapy focuses on disrupting melanin production. Retinoids are central to this approach, with trifarotene showing promise in reducing both pigmentation and atrophic scars (figure 2).14-17
Figure 2. Mean absolute change from baseline in total atrophic acne scar counts.17 P values refer to the Student’s ttest for paired samples performed on the intra-subject difference between trifarotene 50 lg/g and vehicle at each analysis visit. *0.01 < P value < 0.05; **0.001 < P value < 0.01; ***0.0001 < P value < 0.001; ****P value< 0.0001
In a six-month study, the combination of trifarotene with a supportive skincare regimen and sun protection resulted in significant improvement in post-AV hyperpigmentation index and overall disease severity scores between weeks 12 and 24, with high levels of patient satisfaction and adherence to treatment.18
Emphasis was given on early acne control using retinoids and benzoyl peroxide to prevent new lesions, minimize pigmentation, and reduce scarring risk. Patient education is key—AIMH may fade slowly, but adherence and photoprotection speed resolution.19
Dr Handog also emphasized that acne scar treatment is a multi-step process, beginning with careful evaluation and classification of the scars, identifying the patient’s primary concern, and selecting appropriate procedures to target different components of the scarring process. She reiterated setting realistic expectations—that acne scars can be improved, but not completely erased.
Beyond the Surface: Topical and Procedural Synergy in Acne Scar Treatment
Dr Adraneda discussed four clinical cases to illustrate the synergy between topical and procedural interventions.
One involved a 52-year-old woman whose scars worsened with aging skin. Despite previous laser sessions, visible improvement was achieved through RF microneedling, subcision, PLLA, and skin boosters. Trifarotene was introduced on day four post-procedure, alongside antioxidants and sun protection.
Another patient, a 25-year-old with deep boxcar and rolling scars resistant to CO₂ lasers, received a combination of RF microneedling, TCA CROSS, subcision, CO₂ laser, PLLA-SCA, and exosomes. Significant scar improvement was noted within a month, with trifarotene aiding in post-treatment remodeling.
A third case featured a 24-year-old with mixed scars and erythema treated using TCA CROSS, CO₂ laser, hyaluronic acid, and exosomes. Trifarotene initiated on day five supported pore refinement and erythema reduction.
Lastly, a 22-year-old male showed marked improvement in texture and scar depth after a similar multimodal regimen. Mild PIH was addressed with ongoing trifarotene use.
Dr Adraneda emphasized that effective scar treatment requires individualized strategies, combining targeted procedures with post-treatment retinoids to enhance collagen remodeling and support long-term results. Photoprotection and barrier care are essential, along with managing patient expectations to ensure satisfaction and adherence.
Red Alert: Multimodal Strategies for Acne-Related Erythema, Discoloration and Depression
Dr Valencia showcased the importance of early inflammation control and tailored combination therapies in managing post-acne erythema, hyperpigmentation (PIH), and scarring through four patient cases.
A 22-year-old male with post-acne erythema and atrophic scars was treated with a regimen of topical tranexamic acid, vitamin C, and adapalene/benzoyl peroxide. Alternating azelaic acid peels and quasi long-pulsed Nd:YAG laser sessions significantly reduced erythema by week 12, with no adverse events.
In a 24-year-old female with active acne and PIH, treatment combined clindamycin, azelaic acid, and trifarotene, plus Q-switched Nd:YAG laser. By week 8, pigmentation and acne lesions had resolved. Trifarotene’s anti-inflammatory and keratinocyte turnover properties were key to her rapid improvement.
The next two cases involved atrophic scarring. A 28-year-old male unable to commit to regular procedures underwent a single-visit combination treatment with fractional CO₂ laser, TCA CROSS, and subcision, supported by topical adapalene, azelaic acid, and vitamin C. After six months, notable scar shallowing and improved texture were observed.
Similarly, a 42-year-old female with limited follow-up access showed moderate improvement in rolling scars and PIH over four months solely on a combination of topical medications.
Dr Valencia concluded that prevention starts with controlling inflammation. Combining multifunctional topicals like retinoids with tailored procedures remains central in addressing acne-related erythema, discoloration, and scarring, especially in patients with diverse treatment needs and constraints.
Glow On: Combination Injectable Treatments for Acne Scar
Acne vulgaris affects 85% of adolescents worldwide, with 95% developing scarring, mostly atrophic and characterized by tissue loss. Improving skin quality is key to restoring self-confidence. Dr Puyat highlighted the role of dermal fillers in managing these scars, focusing on non-animal stabilized hyaluronic acid (NASHA; Restylane™ Skin Boosters) and Poly-L-lactic acid (PLLA; Sculptra®).20,21
Cross-linked NASHA not only provides volume but also stimulates collagen production by activating growth factors, inhibiting collagen breakdown, and stretching fibroblasts. Available in two formulations—20 mg/ml NASHA (Restylane Vital) and 12mg/ml NASHA (Restylane Vital Light)—the former is preferred for acne scars. Its unique delivery system allows precise microdroplet injections for targeted treatment. 20,21
PLLA, is a semi-permanent filler approved for soft tissue augmentation. It improves volume loss by stimulating fibroblasts to produce collagen gradually.21
Injectable fillers are best suited for boxcar and rolling type of acne scar. During the discussion, Dr Puyat also presented her technique utilizing both NASHA and PLLA.
Dr Puyat emphasized a tailored, multimodal approach combining these injectables with other cosmetic procedures to maximize outcomes. While single treatments can improve scars, combining multiple sessions of NASHA-based boosters and PLLA enhances collagen remodeling and skin texture, offering progressive, synergistic reduction of acne scars—especially rolling and boxcar types.
This integrative strategy addresses both volume loss and skin quality, providing patients with lasting improvements and renewed confidence.
From Inflammation to Renewal
The lectures presented a rich, multifaceted exploration of acne and its sequelae, highlighting advances in topical therapies, procedural innovations, and combination treatments. Experts discussed personalized, multimodal approaches—integrating retinoids, lasers, chemical peels, and injectable fillers—to effectively address acne lesions, erythema, hyperpigmentation, and diverse scar types. Prevention, patient education, and realistic goal-setting were emphasized as vital to optimizing outcomes.
Committed to advancing dermatological education, Galderma takes pride in hosting impactful scientific events that deliver valuable insights from leading experts. By actively supporting healthcare professionals with timely, relevant, and scientifically accurate information, the company fosters improved patient care and drives ongoing progress in dermatology.