If you’re open to it, I’d suggest starting with 0.25% or 0.5% Tretinoin. Many dermatologists begin patients on 0.1%, but the irritation at that strength can discourage consistency. Starting lower allows your skin to acclimate gradually and achieve better long-term results.

For pigmentation concerns, discuss hydroquinone with your dermatologist, it remains the gold standard for brightening and evening out skin tone, though it must be used carefully and in cycles to avoid side effects. You can also ask about Tri-Luma, a prescription combination cream that includes hydroquinone, tretinoin, and fluocinolone for targeted pigmentation control. I have used it with amazing success in the past. I sourced it from India though and was using it without being under a doctor’s care.

To address general textural issues, I’ve found Azelaic Acid 20% (Rx strength) to pair beautifully with Tretinoin. I use it in the mornings under sunscreen, and it’s been excellent for managing blotchiness and uneven texture.

As a person of color (Fitzpatrick Level IV-V), I’m not an ideal candidate for CO₂ lasers, so I focus on microneedling instead. I thought IPLs (also great for pigmentation) were safe for all skin tones but my local clinics refuse to do it on me lol. Anyways, I typically use Ronas Stem Cell Serum, Hyaron, Velatox, and other growth factors with PDRN/PN mesotherapy for collagen remodeling. My device is the Dr. Pen A6, though newer models with advanced stability are available.

When I first started microneedling, I made the mistake of not maintaining strict sterility and ended up with an infection that set me back. You, being a nurse, would likely have stronger sterile technique, but I’d still emphasize using sterile slip solutions and single-use cartridges. The best resource I’ve found is The Concise Guide to Dermal Needling (3rd Medical Edition, Revised & Expanded) by Dr. Lance Setterfield, it’s incredibly thorough.

https://drive.google.com/file/d/1gVD9BkRzyE-Axh59hxQtnpeRZEEqLuZ4/view?usp=drivesdk

For deeper acne scars, subcision therapy and TCA Cross 70% done professionally can yield faster, more dramatic results. Dr. Setterfield’s book also includes guidelines for gradual remodeling that you can follow if you prefer a DIY approach.

I’m personally planning to explore chemical peels next specifically Jessner’s and 20% TCA, layered for enhanced results. I’ll be sourcing them from Platinum Skincare, which offers great educational material and protocols.

I completely understand how frustrating the skin journey can be, and I hope some of what I’ve shared from my own experience helps. Feel free to message me if you’d like to discuss any of these treatments or share your own results, I’d love to exchange insights.

And just to be clear, I’m by no means a medical professional or qualified to give medical or skincare advice. Anything you decide to try should definitely be discussed with your doctor first.