How to Get Rid of Pitted Acne Scars, According to Derms

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If you’ve experienced acne– especially the deep, under-the-skin cysts that are super painful– you've likely experienced its after-effects as well, which tend to stick around long after the initial breakout subsides. These effects can include hyperpigmentation and even scarring. In some cases, scars can take the appearance of dents in the skin. And those pitted acne scars can take months—if not years—to disappear. Or if the scar doesn't subside on its own, it may require the intervention of a dermatologist for a more permanent fix via laser or fillers.

But, there are several solutions to treating and fading pitted acne scars, both with and without a professional's intervention. We’ve reached out to three board-certified dermatologists for their advice on the treatment options that are available for acne scars. Keep reading to learn how to get rid of pitted acne scars—from recommended skincare ingredients to available treatments and procedures.

Meet the Experts

Brendan Camp, MD, is a double board-certified dermatologist and dermatopathologist at MDCS Dermatology in New York City. He specializes in both medical and cosmetic dermatology.
Jeriel Weitz, DO, FAAD, is a board-certified dermatologist specializing in general, surgical, and cosmetic dermatology based in Florida.
Jessica Weiser, MD, FAAD, is a board-certified dermatologist, the founder of Weiser Skin MD in New York City, as well as an assistant clinical professor of dermatology at Columbia University.

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.

How do you get pitted acne 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 create a small pit-like structure on the face—hence the name.

Types of Pitted Acne Scars

According to dermatologist, Brendan Camp, MD, pitted acne scars are often categorized into three types based on their appearance.

Boxcar scars: "Boxcar scars are broad and have sharp, well-defined edges. A good example is a chicken-pox scar," says Dr. Camp.
Ice pick scars: "Ice pick scars are small, narrow, and deep. Because they are deep, they tend to be difficult to treat," he says.
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," adds Dr. Camp.

How to Prevent Pitted Acne Scars

The easiest way to prevent pitted acne scars is by treating your acne prior to scarring. "Scarring from acne is caused by the inflammatory response that occurs in response to acne lesions," says dermatologist, Jeriel Weitz, MD. "The best way to prevent acne scars from forming is to properly treat the initial acne lesions. Delaying treatment of acne lesions can increase your risk of scarring. Additionally, try not to pick or squeeze acne lesions as this increases inflammation and your risk of scarring. I recommend seeing a board-certified dermatologist as soon as possible who can help create a treatment regimen for your acne."

How to Get Rid of Pitted Acne Scars

"Acne scars are depressions in the skin as a result of prior inflammation. Acne scars can change the appearance, contour, and texture of skin," says Dr. Camp. Left unaddressed, pitted acne scars can take time to fade. In some cases, they may never disappear completely. The indentation of pitted scars typically do not fill in on their own but discoloration can improve over time. "To treat acne scars, new collagen needs to be made to correct the atrophy created by an acne scar, or scar tissue needs to be broken up to release the tethering that creates an indentation," he adds.

Here are treatments you can turn to in order to fade the appearance of pitted acne scars.

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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 (AHA), like glycolic and lactic acids, are hydrophilic so they don’t penetrate pores as well. Yet, they efficiently exfoliate dead skin and prevent pores from clogging. Dr. Camp suggests using a gentle face cleanser with salicylic acid that can be used to treat acne on the face, shoulders and the back. We recommend CeraVe SA Body Wash for Rough & Bumpy Skin or Paula's Choice Weightless Body Treatment 2% BHA for the body, and La Roche-Posay Effaclar Medicated Acne Face Wash for the face.

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Retinoids

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," says Dr. Camp. He recommends Differin Adapalene Gel, which used to be a prescription product but is now available over-the-counter.

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Chemical Peels

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. "Resurfacing procedures such as resurfacing lasers, chemical peels and dermabrasion are effective options, as is microneedling and even radiofrequency devices which work by stimulating the production of new collagen," adds Dr. Weitz.

Gentle on the skin but tough on scars, chemical peels often get a bad rap for being harsh or painful. When performed properly, they are painless and can provide deep exfoliation.

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Microneedling with Radio Frequency

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.

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Accutane

A common and potent prescription medication, isotretinoin (also known as Accutane) is an acne treatment that is recommended for treating scarring acne. When other forms of treatment have been ineffective and exhausted, Dr. Camp says that isotretinoin can provide 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.

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Fraxel Lasers

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, according to Dr. Camp. Non-ablative lasers are much less invasive than ablative, requiring multiple treatments.

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Subcision Procedure

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. But, be warned, Dr. Camp points out it can cause bruising.

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Acne Gel

Dr. Camp recommends looking for acne gels that can either be used to treat the full face or as a spot treatment. Make sure the formula contains azelaic acid and salicylic acid for extra exfoliation in order to help reveal a smoother skin surface.

Key Ingredients

Azelaic acid is derived from grains and works to kill bacteria, exfoliate dead skin, and brighten skin complexion.

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Fillers

Injections fillers, such as those made with 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." Other options for fillers include Sculptra (poly-L-lactic acid), autologous fat transfer and FDA-approved Bellafill (polymethyl methacrylate microspheres with collagen).

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Dermabrasion

Dermabrasion (of varying depths) works in a similar way to chemical peels. It relies on an abrasive, exfoliating material to remove the top layer of skin instead of a liquid chemical. Dermabrasion can also help limit breakouts and reduce excess oil in pores.

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Radio Frequency

Skin tightening using radio frequency can help reduce the appearance of pitted acne scars. It creates kinetic energy that triggers the body's healing process. As a result, the skin produces additional collagen, softening the appearance of scars.

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TCA CROSS

TCA CROSS stands for Trichloroacetic Acid Chemical Reconstruction of Skin Scars. It is a type of chemical peel procedure used to treat acne scarring. Dermatologist, Jessica Weiser, MD, says icepick scars in particular may benefit from the procedure. Your dermatologist will place trichloracetic acid (or TCA) into the depth of the scars in order to slowly induce a healing response, she says. This will close off the depth of the scar.

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Punch Excisions

"This technique involves removing the scar with a small excision or punch tool, and suturing the skin together to essentially remove the acne scar and replace it with a smaller or less noticeable one," says Dr. Camp. Tiny cylinders of skin are removed to stimulate a wound healing response, adds Dr. Weiser. She also notes that this procedure has become less popular with time in favor of laser, which causes a "better tissue contraction and aesthetic result."

Article Sources

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