Dealing with acne is can be frustrating, to say the least. And when you throw acne scars into the mix, it can be even more complicated. Like 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 board-certified dermatologist Dr. Brendan Camp for expert insight into managing, treating, and eliminating the pitted acne scars that breakouts can leave behind.
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. Pitted acne scars encompass three main types of acne scars: ice pick scars, boxcar scars, and rolling scars.
Unlike hypertrophic scars (keloids) which result from an overproduction of collagen, 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.
According to Dr. Camp, pitted acne scars are often categorized based on their appearance, within three common types:
- Boxcar scars: "Boxcar scars are broad and have sharp, well-defined edges. A good example is a chicken-pox scar."
- Ice pick scars: "Ice pick scars are small, narrow, and deep. Because they are deep they tend to be difficult to treat."
- 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."
Below, Dr. Camp shares his top recommendations for treating pitted acne scars.
Give Your Skin a Deep, Exfoliating Clean with Salicylic Acid
Salicylic acid is a beta-hydroxy acid (BHA) 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 (AHAs), like glycolic and lactic acid, are hydrophilic so they don’t penetrate pores as well, but are effective at exfoliating dead skin and prevent pores from clogging. Dr. 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, explains Dr. Camp. "The long-term use of retinoids is thought to help with collagen production." He recommends Differin gel, which used to be a prescription adapalene product, but is now available for 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 Dr. Camp.
Gentle on the skin but tough on scars, chemical peels often get a bad wrap for being harsh or painful, but when performed properly they can provide deep exfoliation and are painless.
Give Microneedling with Radiofrequency 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 radiofrequency, it becomes a bit more aggressive—with energy being released deeper within the skin to trigger a more robust inflammatory and
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, Dr. 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 Dr. 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 is more aggressive and removes a narrow column of skin.
Ask Your Dermatologist About 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; though Dr. Camp warns it can be associated with bruising.
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. Dr. Camp says that Acne Gel by PCA can be used to treat the full face or as a spot treatment and contains both azelaic acid and salicylic acid for extra exfoliation, revealing a smoother 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. Dr. 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 Them Away
Dermabrasion (of varying depths) works similarly to chemical peels, except the process uses an abrasive, exfoliating material to remove the top layer of skin, instead of a liquid chemical.
Tighten Your Skin with Professional Radiofrequency
Skin tightening with radiofrequency energy can help make depressed scars less obvious, and creates kinetic energy that triggers the body's healing process.