Dealing with acne can be frustrating, to say the least. And when you throw acne scars into the mix, it can get even more complicated. As with most scars on the body, there's no magic serum or tonic to make acne scars magically disappear overnight. The same is true for pitted acne scars, the ones that tend to leave behind a hollow, "pit-like" impression in the skin.
Despite being among the most common skincare conditions, both acne and acne scars can look, feel, and respond to treatments differently for each individual. So, we've tapped double board-certified dermatologist Brendan Camp for expert insight into managing, treating, and eliminating the pitted acne scars that breakouts can leave behind.
Below, Camp shares 11 recommendations for treating pitted acne scars.
Meet the Expert
- Brendan Camp, MD, is a double board-certified dermatologist specializing in medical and cosmetic dermatology at MDCS Dermatology in New York City.
What Are Pitted Acne Scars?
Pitted acne scars are a name given to acne scars that are characterized by a hollow, indented impression in the skin. This concave appearance is due to a sudden loss of collagen. Unlike hypertrophic scars (keloids), which result from an overproduction of collagen, pitted acne scars result from the damage and inflammation of deep breakouts, which create a small pit-like structure on the face—hence the name.
According to Camp, pitted acne scars are often categorized based on their appearance, within three common types: boxcar scars, ice pick scars, and rolling scars.
- Boxcar scars: "Boxcar scars are broad and have sharp, well-defined edges. A good example is a chicken-pox scar," says Camp.
- Ice pick scars: "Ice pick scars are small, narrow, and deep. Because they are deep, they tend to be difficult to treat," Camp explains.
- Rolling scars: "Rolling scars are similar to boxcar scars but have smooth, undulating edges that make the skin surface look uneven. They tend to be more shallow," he says.
Give Your Skin a Deep, Exfoliating Clean With Salicylic Acid
Salicylic acid is a beta-hydroxy acid that is lipophilic, which means it likes to mingle with oils. This property allows it to penetrate deep into pores and clean them out. Alpha hydroxy acids, like glycolic and lactic acids, are hydrophilic, so they don’t penetrate pores as well, but they are effective at exfoliating dead skin and preventing pores from clogging. Camp suggests cleansing with this gentle face cleanser by CeraVe, which contains salicylic acid and can be used to treat acne on the face, shoulders, and back.
Use Retinoids to Boost Collagen Production
Retinoids treat acne by regulating or normalizing the process of cell turnover, which prevents blocked pores and the formation of acne bumps. "The long-term use of retinoids is thought to help with collagen production," explains Camp. He recommends Differin gel, which used to be a prescription adapalene product but is now available to purchase in stores.
Try a Chemical Peel
A quality chemical peel can expose fresh, healthy tissue and stimulate the production of new collagen to make pitted scars look less pronounced, according to Camp.
Gentle on the skin but tough on scars, chemical peels often get a bad rap for being harsh or painful, but when performed properly, they can provide deep exfoliation and are painless.
Give Microneedling With Radio Frequency a Try
Microneedling creates small, narrow, superficial areas of mechanical injury that work to stimulate the repair response, increase collagen production, and improve scar appearance. When combined with radio frequency, it becomes a bit more aggressive—with energy being released deeper within the skin to trigger a more robust inflammatory and collagen response.
Ask Your Dermatologist About Accutane
A common but powerful prescription medication, isotretinoin (also known as Accutane) is a prescription acne medication that is specifically indicated for scarring acne. When other forms of treatment have been ineffective and exhausted, Camp says that isotretinoin is helpful for providing a durable remission in scarring acne. You should only begin an Accutane prescription under the guidance of your board-certified dermatologist, and it can be helpful to go into your appointment with some background knowledge of its potential side effects.
Look Into Fraxel Laser Treatments
According to Camp, Fraxel lasers can be non-ablative, meaning that they emit columns of heat beneath the skin while leaving the surface intact, or ablative, which are more aggressive and remove a narrow column of skin. Non-ablative lasers are much less invasive than ablative, requiring multiple treatments for clinical results.
Consider a Subcision Procedure to Break up Scars
Performed in-office by a dermatologist, a subcision procedure involves breaking up the cord of scar tissue responsible for tethering the skin down and making a depression (the "pitted" part of the scar). During this procedure, a needle is inserted into the skin to break the collagen cord. Camp warns it can be associated with bruising, though.
Apply an Acne Gel to Exfoliate and Brighten
Azelaic acid is derived from grains and works to kill bacteria, exfoliate dead skin, and brighten skin complexion. Camp says that Acne Gel by PCA can either be used to treat the full face or as a spot treatment. It contains both azelaic acid and salicylic acid for extra exfoliation, revealing a smoother skin surface.
Try to Plump Indentations With Hyaluronic Acid
Injections with fillers, such as hyaluronic acid, can push out and plump up puckered skin to make it more even. Camp explains that hyaluronic acid "is a natural component of the extracellular matrix, the gel that surrounds skin cells and adjoining structures."
Try Dermabrasion to Slough Scars Away
Dermabrasion (of varying depths) works in a way that's similar to chemical peels, except the process uses an abrasive, exfoliating material to remove the top layer of skin, instead of a liquid chemical. Even more, dermabrasion can help with breakouts and reduce excess oil in pores.
Tighten Your Skin With Professional Radio Frequency
Skin tightening with radio frequency energy can help make depressed scars less obvious. It creates kinetic energy that triggers the body's healing process. As a result, skin produces more collagen and softens the appearance of scars.
What are pitted acne scars?
Pitted acne scars result from the damage and inflammation of deep breakouts, which causes the indented appearance of a pitted acne scar—hence the name—creating a small pit-like structure on the face.
Do pitted acne scars go away?
Left unaddressed, pitted acne scars can take quite a while to fade and, in some cases, may never disappear completely.
Do indented scars fill in over time?
In most cases, the indentation does not fill in on its own but discoloration can improve over time.
Connolly D, Vu HL, Mariwalla K, Saedi N. Acne scarring—pathogenesis, evaluation, and treatment options. J Clin Aesthet Dermatol. 2017;10(9):12-23.
Zeichner JA. The use of lipohydroxy acid in skin care and acne treatment. J Clin Aesthet Dermatol. 2016;9(11):40-43.
Moghimipour E. Hydroxy acids, the most widely used anti-aging agents. Jundishapur J Nat Pharm Prod. 2012;7(1):9-10.
Mukherjee S, Date A, Patravale V, Korting HC, Roeder A, Weindl G. Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety. Clin Interv Aging. 2006;1(4):327-348.
Singh A, Yadav S. Microneedling: Advances and widening horizons. Indian Dermatol Online J. 2016;7(4):244-254.
Chandrashekar BS, Sriram R, Mysore R, Bhaskar S, Shetty A. Evaluation of microneedling fractional radiofrequency device for treatment of acne scars. J Cutan Aesthet Surg. 2014;7(2):93-97.
Rasi A, Behrangi E, Rohaninasab M, Nahad ZM. Efficacy of fixed daily 20 mg of isotretinoin in moderate to severe scar prone acne. Adv Biomed Res. 2014;3:103.
Chandrashekar B, Nandini A. Acne scar subcision. J Cutan Aesthet Surg. 2010;3(2):125-126.
Davis EC, Callender VD. Postinflammatory hyperpigmentation. J Clin Aesthet Dermatol. 2010;3(7):20-31.
Wollina U, Goldman A. Fillers for the improvement in acne scars. Clin Cosmet Investig Dermatol. 2015;8:493-499.
Lloyd JR. The use of microdermabrasion for acne: a pilot study. Dermatol Surg. 2001;27(4):329-331.
Simmons BJ, Griffith RD, Falto-Aizpurua LA, Nouri K. Use of radiofrequency in cosmetic dermatology: focus on nonablative treatment of acne scars. Clin Cosmet Investig Dermatol. 2014;7:335-339.