Abstract

Objectives: To define, describe, and differentiate causes of acne scarring like acne fulminans, rosacea fulminans and acne conglobata. To discuss laser remodelling of moderate to severe acne scars. To discuss ideal management of post-inflammatory hyperpigmentation (PIH) and post-inflammatory erythema (PIE) in brown skin. Introduction: The successful treatment of acne fulminans, rosacea fulminans and flares of acne conglobata requires a successful management of the inflammatory phase of these diseases. When the disease activity is already controlled, assessment of the type and severity of scarring is recommended and a logical treatment plan should be created. Materials / method: Case studies of moderate to severe acne scarring in Filipinos with Skin phototype IV will be presented. The treatment of the inflammatory phase will be discussed. This will be followed by an evaluation how PIH, PIE, and scars will be treated with topical agents and laser remodelling. Baseline and post-treatment photos will be presented. Results: 8 cases of Filipinos (6 males, 2 females) were carefully diagnosed with any of the following conditions: Acne fulminans, Rosacea fulminans, and Acne conglobata. The inflammatory phase was treated with a combination of any of the following: Methylprednisolone; oral antibiotics; and oral isotretinoin. Light emitting diode (blue light (40-495 nm) was used in very severe cases twice weekly for 6 weeks. Post-inflammatory hyperpigmentation was treated with a combination of non-irritating skin lightening agents . Erbium:YAG resurfacing and 577 nm lasers were used for skin resurfacing and PIH/PIE. Conclusion: The treatment to moderate to severe acne scarring should be well-planned-addressing the inflammatory phase first, then the PIH, PIE and scarring after. Non-irritating new generation skin lightening agents are recommended. A combination of fractional Er:YAG laser and 577 nm yellow lasers is recommended for skin resurfacing and remodelling of the scars.