How do you treat significant keloidal acne scarring on the back of a teenager?

Firstly, their acne needs to be controlled and stable prior to treating the scars themselves unless any of the keloids are particularly symptomatic. My decision-making is shared with the patient and based on many different factors including skin type, pain tolerance, insurance coverage/budget, scar location/size/thickness, response to previous treatments and for females, whether pregnant/lactating/trying to become pregnant.

The most common treatment I use is the intralesional injection of cortic...