Scarring is a common but difficult-to-manage outcome of acne vulgaris. The intricate balance between collagen degradation and its inhibition is agitated during the formation of acne scars. Physicians mostly rely on invasive, non-topical modalities for treating acne scars which might not be suitable for all patients. Furthermore, these procedures also need maintenance therapies.

Bikash C and Sarkar R describe that topical agents can be utilized as individual therapy, in combination with other modalities, or delivered via assisted technology like iontophoresis. Retinoids have long been used in the prevention and treatment of acne scars. Tacrolimus and glycolic acid are among the newer sole agents investigated. Ablative lasers like Er: YAG, CO2, and Microneedling are often used in combination with topical agents like silicone gel, plasma gel, lyophilized growth factors, platelet-rich plasma, insulin, and mesenchymal stem cells. These procedures not only boost the permeability of the topical agents but also improve acne scars. Iontophoresis has shown benefits in increasing the delivery of topical estriol and tretinoin.

However, there exists a lack of evidence to support the widespread use of these topical agents, and therefore, further, well-designed studies are needed.

Bikash C, Sarkar R. Topical management of acne scars: The uncharted terrain. Journal of Cosmetic Dermatology. 2023. https://doi.org/10.1111/jocd.15584