As if acne breakouts weren’t bad enough, when they finally clear, you may be left with little indented marks on your skin instead. These pitted acne scars are tricky to treat but there are a variety of treatments that can help. This article will help to explain just how to get rid of pitted acne scars.
What Are Pitted Acne Scars?
Pitted acne scars, otherwise known as atrophic acne scars, are the indented marks left behind on your skin after a fairly severe acne breakout.
There are three main types of pitted acne scars: icepick, boxcar, and rolling.
The difference between the three types of pitted acne scars are generally down to their depth and width. For example:
- Icepick scars are deeper than they are wide.
- Boxcar scars are wider than they are deep.
- Rolling scars are the shallowest and the widest type of pitted acne scars and leave a ‘ripple effect’ on your skin.
If you’re interested in a more detailed explanation of the biology behind pitted acne scars, check out: Acne Scars vs Acne Marks.
What Causes Pitted Acne Scars?
Pitted acne scars are usually caused by severe inflammatory acne, especially if spots have been picked or squeezed.
When an acne pimple is healing, it goes through the same processes as any other wound. In order for your skin to heal itself, it needs to create new collagen and tissue.
Certain enzymes regulate the amount of collagen that your skin produces during this process. If these enzymes are unbalanced, it can lead to too little or too much collagen being produced.
If too much collagen is produced when an acne pimple is healing, it causes a raised, or hypertrophic, acne scar.
When too little collagen is produced as the acne pimple heals, it causes a pitted, or atrophic, acne scar.
The majority of acne scars (80-90%) are atrophic.
How To Get Rid Of Pitted Acne Scars
The first step in how to get rid of pitted acne scars is to prevent them from forming in the first place. If active acne is not treated, then new scars will continue to form.
The most effective way to prevent or reduce acne scarring is to treat inflammatory acne as early as possible and avoid picking at spots and pimples.
Retinoids are derivatives of vitamin A that increase skin cell turnover (your skin’s natural exfoliation process). They are also able to boost collagen production and treat the fine lines and wrinkles caused by sun damage.
Research suggests that retinoids, such as tretinoin and adapalene, are able to block an important inflammatory pathway that is associated with acne and acne scarring . This means that they can treat active acne and prevent pitted acne scars from forming.
Some forms of retinoid are also able to help get rid of pitted acne scars after they’ve already formed. For example, 0.1% tazarotene gel was as effective as microneedling at improving the appearance of pitted acne scars  and multiple studies have found 0.3% adapalene gel can improve pitted acne scars after 24-weeks of use .
Retinoids + Glycolic Acid
Glycolic acid is an alpha-hydroxy acid that acts as a chemical exfoliant by loosening the top layer of skin and removing dead skin cells. It can also help boost collagen production which means it can help to get rid of pitted acne scars.
Retinoids and glycolic acid can complement each other’s effects when combined together. Retinoids increase the rate that new skin cells are brought to the surface of the skin and glycolic acid helps them to shed faster. In addition, both ingredients can boost collagen production.
One research study found that the combination of 0.025% retinoic acid and 12% glycolic acid improved pitted acne scars after 12-weeks of use . Other research concluded that 0.1% retinaldehyde combined with 6% glycolic acid improved pitted acne scars as well as treating active acne and discoloration (PIE & PIH) .
Microneedling is a treatment that uses tiny needles to puncture your skin, allowing topical ingredients to penetrate into your dermis, initiating a wound-healing response, and boosting collagen production.
Research suggests that microneedling can improve pitted acne scars by 50-75% .
While there are a number of microneedling devices available for home use, it’s much safer for your skin to have a professional perform the treatment. This is mainly due to the fact that they have devices with sterile, single-use attachments which reduces the risk of infections and skin damage.
Laser treatments use focused beams of light to target light-absorbing molecules within your skin including melanin (the substance that gives your skin its color) and hemoglobin (the substance that makes your blood red).
The light energy from the laser is transferred to heat and causes damage to the melanin or hemoglobin which helps to reduce pigmentation and redness. The damage also initiates a wound healing response, causing your skin to produce more collagen.
There are various different types of laser that can help to get rid of pitted acne scars. Some also help treat other skin conditions that often accompany pitted acne scars, such as PIH, PIE, and active acne.
Vascular lasers (e.g. PDL) that target hemoglobin are useful if you still have active acne as well as pitted acne scars and can also help with PIE acne marks.
Non-ablative fractional lasers (e.g. Fraxel) mainly target water but are also absorbed to some extent by melanin and hemoglobin. They are a great option for improving overall skin texture, pitted acne scars, PIH, and sometimes PIE. However, they aren’t suitable if you’re still having active acne breakouts as they can make this worse.
Fractional lasers may be better at treating some types of pitted acne scars over others, with less improvement in icepick scars than in boxcar and rolling scars .
Other Products That May Get Rid Of Pitted Acne Scars
Although there is little research to support their effectiveness at getting rid of pitted acne scars, a number of skincare ingredients have plenty of research to back up their ability to boost collagen production.
- Vitamin C
- Centella Asiatica
- Glycolic Acid (particularly when combined with other ingredients)
Other Tips For How To Get Rid Of Pitted Acne Scars
- Wear Sunscreen Every Day – The UV radiation from the sun destroys the collagen in your skin and leads to premature skin aging. In order to get rid of pitted acne scars, you need to increase the amount of collagen within your skin, and preventing unnecessary collagen loss is the best place to start!
- No Picking/Squeezing! – The more you squeeze and pick at spots, the more inflamed your skin becomes, and the more likely the spot is to scar than if left alone to heal on its own.
- Moisturize – Dehydrated skin exaggerates any textural irregularities on your skin, including pitted acne scars, wrinkles, and pores. Increasing your skin hydration can make your skin appear plumper and instantly improve the appearance of wrinkles and pitted acne scars.
- Exfoliate – If you have a lot of dead skin cells sitting on the surface of your skin it can leave your skin looking dull and tired and, like dehydrated skin, can exaggerate the appearance of pitted acne scars. Exfoliation helps to remove this layer of dead skin and reveal brighter and smoother skin.
- Patience Is Key! – It takes approximately three months for your skin to produce new collagen which means that this is the earliest that you may be able to see results. It will usually take longer than this to see significant results (most studies took at least six months).
Pitted acne scars are the indented marks left on your skin after a bad acne break out. They are caused when your skin doesn’t produce enough collagen when the acne pimple is healing.
There are a number of ways how to get rid of pitted acne scars including topical treatments such as retinoids and glycolic acid, and professional treatments including microneedling and laser treatments.
Most treatments are going to take at least six months to see any substantial improvements but you may notice some subtle results after three months.
- Tan, J., Tanghetti, E., Baldwin, H., Stein Gold, L. & Lain, E. (2019). ‘The role of topical retinoids in prevention and treatment of atrophic acne scarring: Understanding the importance of early effective treatment’, J Drugs Dermatol., 18(3), 255-260. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30909329
- Afra, T., Ramzi, M., Narang, T. et al. (2018). ‘Topical Tazarotene gel 0.1%, as a novel treatment approach for atrophic postacne scars: A randomized active-controlled clinical trial’, JAMA Facial Plast Surg., 21(2), 125-132. Available at: https://jamanetwork.com/journals/jamafacialplasticsurgery/article-abstract/2714234
- Loss, M., Leung, S., Chien, A. et al. (2018). ‘Adapalene 0.3% gel shows efficacy for the treatment of atrophic scars’, Dermatol Ther., 8(2), 245-257. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6002315/
- Chandrashekar, B., Ashwini, K., Vasanth, V. & Navale, S. (2015). ‘Retinoic acid and glycolic acid combination in the treatment of acne scars’, Indian Dermatol Online J., 6(2), 84-88. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4375771/
- Dreno, B., Katsambas, A., Pelfini, C. et al. (2007). ‘Combined 0.1% retinaldehyde/ 6% glycolic acid cream in prophylaxis and treatment of acne scarring’, Dermatology, 214(3), 260-267. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17377389/
- Dogra, S., Yadav, S. & Sarangal, R. (2014). ‘Microneedling for acne scars in Asian skin type: an effective low cost treatment modality’, J Cosmet Dermatol., 13(3), 180-187. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25196684/
- Sardana, K., Manjihi, M., Garg, V. & Sagar, V. (2014). ‘Which type of atrophic acne scar (ice-pick, boxcar, or rolling) responds to nonablative fractional laser therapy’, Dermatol Surg., 40(3), 288-300. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24447255/