Pitted Acne Scars: Why They Show Up and How to Get Rid of Them

But the marks it can leave behind are an entirely different ballgame, ranging from hyperpigmentation to full-on indentations.

The pitted scars are particularly troublesome. Not only can they require a variety of treatments, but they can also take quite a while to fade.

And, in some cases, they’ll never disappear completely.

Wondering how to prevent pitted acne scars and manage any current ones? Here’s everything you need to know about those pesky pits.

Why they happen

Not all acne scars.

However, scarring can affect 95 percent of people with acne, so it’s far from uncommon.

So why does it happen?

“Whether acne spots lead to scars depends on a number of factors,” says consultant dermatologist Dr. Sharon Wong. This includes “the type of acne, whether there’s been any picking or squeezing, and your own healing tendencies.”

But, she adds, “inflammation is the key factor that determines whether acne will scar.

“This is why the deeper, inflamed cysts and nodules are more likely to scar than whiteheads and blackheads (unless these are picked and squeezed).”

The inflammation damages skin, triggering the wound healing process and affecting production of a pigment called melanin and a protein called collagen.

Excessive melanin production can result in dark marks or hyperpigmentation. And collagen production (or the lack of it) can create all manner of scarring.

Some people are, however, more likely to scar than others.

Instead of healing properly, “the skin in people with a tendency for scarring produces more collagen fibers that pull the skin down and form depressed atrophic acne scars,” says Dr. Yoram Harth, a board certified dermatologist and the medical director of MDacne.

“In other cases,” he adds, “too much collagen production creates a ‘bump’ on the skin, called a keloid scar.”

Types of acne scars

Although all scarring might look similar, there are several distinct types of acne scars.

• Hypertrophic and keloid scars. These are the raised type.
• Atrophic scars. This isthe most common form of scarring. They have a pitted look.

The categorization doesn’t stop there.

As Wong explains, when it comes to pitted scarring, there are three types:

• Rolling scars. These are “relatively shallow with soft, subtle edges creating an undulating contour.”
• Box scars. These are “wider with sharply defined edges.”
• Ice pick scars. These “look like tiny holes, but, in profile, they go deep into the skin like an ice pick or V shape.”

Ways to reduce pitted acne scars

While acne scars can improve in appearance, they might not disappear entirely.

They also tend to require professional help to resurface the skin.

Harth explains that “home remedies and natural products sound appealing, but unfortunately have minimal value in acne scars and dark spots treatment… They can irritate your skin or just be ineffective.”

However, he adds: “post-acne pink spots usually fade away on their own within about 2 to 3 months once the active acne is controlled.”

Darker acne marks can be brightened with medical grade products containing the likes of hydroquinone, arbutin, alpha hydroxy acids (AHAs), beta hydroxy acids (BHAs), and retinoids. As with all skin care, using a daily SPF is important.

Indented scarring is more complicated, as regular skin care is unlikely to make a significant difference.

But there are a number of treatments to try, including lasers, microneedling, and fillers.

Wong stresses that it’s important to only start treating acne scars after your acne has been treated.

This is “not only because each new spot can potentially create a new area of scarring, but also [because] many of these treatments can aggravate or worsen acne.”

Sometimes, a combination of the below is needed, along with topical treatments like retinoids, which boost collagen production.

Whatever kind of scarring you have, book an appointment with an experienced dermatologist before starting any kind of treatment.

Lasers

Laser resurfacing can be effective for mild to moderate scarring.

There are two kinds:

• Ablative. This removes a small piece of skin for a smoother texture.
• Non- ablative. This uses heat to stimulate collagen production and repair skin damage.

Chemical peels

They may sound scary, but, when applied by a dermatologist, chemical peels can remove damaged skin layers and pave the way for a fresher surface.

The chemicals and concentrations used depend on the level of scarring. Common options are glycolic acid and salicylic acid.

Dermabrasion

Dermabrasion works similarly to chemical peels — except it involves a laser or wire brush.

It penetrates deeper than microdermabrasion, so it’s more effective for deeper scars.

Radiofrequency

Radiofrequency energy triggers the skin’s wound healing response to produce collagen and make pitted scarring less visible.

This can be combined with microneedling, which is a procedure that creates small, superficial wounds.

Fillers

In addition to plumping up the skin for cosmetic reasons, fillers can be used to fill in some scars for more even-looking skin.

Subcision

This surgical treatment cuts the bands of collagen under the surface of the skin that tie down atrophic scars, allowing them to bounce back up.

Ways to prevent pitted acne scars

“The best prevention of acne scarring is early treatment of active acne,” Harth says.

Both Harth and Wong also stress the importance of not picking skin or popping pimples, as this puts you at more risk of scarring.

You can try revamping your skin care routine with the following products.

SPF

Harth recommends using an oil-free sunscreen every morning to protect skin.

The American Academy of Dermatology advises a broad-spectrum formula with at least SPF 30.

Gentle exfoliation

When you have acne, the last thing you want to do is create more inflammation.

But, to help treat current breakouts and prevent future ones, there’s a need to keep pores unclogged and encourage skin cell turnover.

Instead of using harsh scrubs, opt for a chemical exfoliant.

Cleansers and serums containing AHAs (like glycolic acid), BHAs (like salicylic acid), and retinols can all help.

Prescription medication

“If over-the-counter acne treatments aren’t resolving the spots after a couple of months of continuous use, it’s time to see your doctor or dermatologist for prescription medication,” Wong says.

These treatments tend to come in a much higher strength, and they can be customized to suit your specific needs.

The bottom line

Acne can mark the skin in a number of ways, leaving discoloration, indentation, or raised scars. Thankfully, there are several treatments to improve all kinds.

Pitted scars can be difficult to treat without the help of a dermatologist, so speaking with a professional is always the best first step.

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