[2010-08-24 22:21:17 - Crystal N. from Ardmore]: Dr. Ringpfeil: I am 27 and acne has always been a huge issue. I have tried Differin Gel, Jan Marini products, Doxycycline, HCTZ, Proactive and Retin-A. All have which failed. After getting pregnant my skin seemd to calm down but I do suffer from some harsh breakouts. I have suffered from cystic acne as well leaving me with awful scars. I have some scars that look like white lumps (not keloids) others look like "craters" and others look like "ice pick". I would love to minimize the appearance of these scars. I use entirely to much make up to try to camaflouge these issues but I think it makes it more noticeable but I do not dare to leave my home without makeup. It is very embarrassing. Since I have such a variety of different scars would one type of treatment be sufficient for all? Would I have to get my current acne under control before proceeding with scar treatment? Also since acne is a "medical condition" would any of the treatments for active acne and acne scar treatment be covered by insurance? Do you think a TCA peel would be appropriate treatment? What is the down time for "punch excision"? Thank you so much for your time.

[2010-08-25 13:52:39 - Dr. Ringpfeil]: Acne and acne scars can be difficult to handle and often lower self-confidence. Acne treatment is important and it is also a prerequisite to some type of scar correction as some treatments such as TCA, resurfacing etc could temporary flare acne. Medications used for acne treatment are typically insurance covered and so are the office visits. The treatment of acne scars is currently not covered by insurances. Unfortunately, insurances explicitly exclude acne scars from coverage. The choice of treatment depends on your skin, your scars and financial means. TCA is one modality for severe scars. Often, punch excisions are usually used as a pretreatment for other, more extensive procedures. You should be evaluated for your needs.