Simultaneous versus stepwise treatment of acne and atrophic scars: a prospective split-face controlled trial

Abstract

Acne frequently coexists with atrophic scars, yet clinical management typically follows a stepwise approach, with limited evidence on the efficacy of simultaneous treatment strategies for both conditions. To address this gap, we conducted a prospective split-face controlled trial involving 30 patients with symmetrical bilateral facial acne lesions and atrophic scars. The right side of the face was assigned to the stepwise treatment group, receiving 30% supramolecular salicylic acid for acne every two weeks for a total of five sessions. Following the resolution of inflammatory lesions, microneedling and subcision were performed for atrophic scars once a month for three sessions. The left side was designated as the simultaneous treatment group, receiving combined therapy (supramolecular salicylic acid, microneedling, and subcision) for both acne and atrophic scars once a month for three sessions.Efficacy and safety were assessed during follow-up. Results demonstrated that the simultaneous treatment regimen was significantly more effective in reducing acne lesions compared to the stepwise approach (P < 0.05), while both regimens showed comparable efficacy in improving atrophic scars (P > 0.05). No significant adverse reactions were observed in either group. Notably, the simultaneous treatment regimen significantly reduced the overall treatment duration and achieved higher patient satisfaction compared to the stepwise approach.In conclusion, the simultaneous treatment of acne and atrophic scars is not only clinically effective and safe but also offers the advantages of shorter treatment duration and enhanced patient satisfaction, making it a promising therapeutic strategy.