Pitted Scars

Pitted scars, are depressions or indentations in the skin that occur when the underlying structure of the skin is deeply damaged. These scars can be caused by various factors, including acne, chickenpox, skin trauma and other skin conditions. Pitted scars can have a significant impact on an individual’s appearance and self-esteem. Understanding the causes and available treatments for pitted scars is essential for those seeking to improve their skin’s texture and appearance.

Get In touch

Door No. 8-2-293/82/A/725/A, Beside FMS
Hitech City Rd, near Daspalla Hotel, CBI Colony,
Jubilee Hills, Hyderabad, Telangana 500033

Causes of Pitted Scars:

Pitted Acne Scars
  1. Acne and Scars: One of the most common causes of pitted scars is severe acne, particularly cystic acne which are usually deep. When acne lesions penetrate deep into the skin, they damage the underlying tissue. During the healing process, due to insufficient collagen production, there is the formation of pitted or depressed scars. Acne scars are categorized into three types: ice pick scars, boxcar scars, and rolling scars, each with distinct characteristics.
  2. Chickenpox: Chickenpox, during healing in few people can leave behind deep pitted scars, once the blisters heal. Scratching or picking at these blisters can exacerbate the scarring, leading to deeper indentations in the skin.
  3. Injuries and Surgery: Physical trauma to the skin, such as cuts, punctures, or surgical incisions, can result in pitted scars if the wound healing process is disrupted. Inadequate or delayed healing can lead to the formation of depressed scars.
  4. Genetic Predisposition: Some individuals are more prone to developing pitted scars due to genetic factors. Their skin may have a tendency to heal poorly or produce insufficient collagen, leading to atrophic scarring.
  5. Inflammatory Skin Conditions: Conditions like eczema, psoriasis, or other chronic inflammatory skin disorders can damage the skin’s structure, resulting in pitted scars.

Types of Pitted Scars:

Ice Pick Scars: These are deep, narrow scars that extend into the dermis. They appear as small holes or punctures in the skin and are often caused by comedonal acne. They look similar to open pores due to their dilated appearance.

Boxcar Scars: These scars are broader and have well-defined edges, creating a box-like appearance. They are usually caused by inflammatory skin conditions such as acne or chickenpox.

Rolling Scars: These scars have a wave-like appearance, caused by fibrous bands of tissue that develop between the skin and the underlying structures. They are often the result of long-term inflammatory skin conditions.

Mixed Scars: These occurs in conditions like trauma, cuts or surgical procedures, where the shape cannot be exact.

Treatments for Pitted Scars:

Treating pitted scars requires a multifaceted approach, as the effectiveness of each treatment can vary based on the scar type and individual skin characteristics. Here are some of the most common and effective treatments for pitted scars:


Topical Treatments:


  1. Retinoids: Topical retinoids, derived from vitamin A, promote skin cell turnover and collagen production. They can help improve the texture and appearance of pitted scars over time, especially when used consistently.
  2. Alpha Hydroxy Acids (AHAs): AHAs, such as glycolic acid, help exfoliate the skin and stimulate new cell growth, which can reduce the appearance of shallow pitted scars.

At Clinic Treatments:

  1. Chemical Peels: It involves application a chemical solution to the skin, causing the top layers to peel off and promoting new skin growth. Medium to deep chemical peels, using trichloroacetic acid (TCA) or phenol, can significantly improve the appearance of pitted scars by promoting collagen remodeling.
  2. Microneedling: Microneedling, also known as collagen induction therapy, involves using fine needles to create controlled micro-injuries in the skin. This process stimulates the body’s natural wound healing response, thereby increasing collagen and elastin production. Multiple sessions of microneedling can improve the depth and visibility of pitted scars. One of the type, Micro Needling Radio Frequency (MNRF) which delivers radiofrequency energy during the creation of micro-injuries into the skin, thereby reaching deeper layer and also by increasing the amount of collagen production. 
  3. Laser Treatments : Fractional Laser Resurfacing – Fractional lasers, such as Fotona, Tribeam etc., can target microscopic columns of skin, promoting collagen production and skin regeneration. This treatment is effective for pitted scars as it can reach deeper skin layers without excessive surface damage.  Ablative Lasers: Ablative lasers, such as CO2 and erbium lasers, remove the top layer of skin, allowing new, healthier skin to form. This method is particularly effective for deeper scars but requires a longer recovery period.
  4. Dermal Fillers: Injectable fillers, such as hyaluronic acid, PLLA etc can be used to fill in the depressions caused by pitted scars. Dermal Fillers provides immediate results by raising the level of the scarred area to match the surrounding skin. However, the effects are temporary, typically lasting several months.
  5. Subcision: Subcision is a minimally invasive surgical technique where a needle is inserted beneath the scar to break up the fibrous bands pulling the skin down. This allows the skin to lift and smooth out over time. It is usually done for puckered scars like acne scars, chicken pox scars, burns or trauma. Subcision is often combined with other treatments like fillers or lasers for better results.
  6. Dermabrasion and Microdermabrasion: Dermabrasion – This procedure involves using a high-speed rotary instrument to sand down the top layers of the skin. It is effective for superficial pitted scars but requires significant downtime and carries a risk of side effects. Microdermabrasion: A less invasive procedure that exfoliates the skin using tiny crystals. It is less effective for deep scars but can improve the texture of milder scars with minimal recovery time.
  7. Punch Techniques: Punch Excision – This surgical technique involves removing the scarred tissue entirely with a small, cookie-cutter-like tool. The resulting wound is then closed with stitches or left to heal naturally. Punch excision is particularly effective for deep ice pick scars. Punch Grafting: Similar to punch excision, but instead of stitching, a skin graft (usually taken from behind the ear) is placed in the excised area. This method is used for very deep scars that cannot be closed easily with stitches.
  8. Bio Remodelling Therapy: PRP/GFC therapy involves using a concentration of the patient’s own platelets to promote healing and collagen production. These can be injected directly into the scar or they can be also applied on the surface of skin after microneedling to enhance the results.

Pitted scars, with their distinct indentations, can be a significant cosmetic concern. However, advancements in dermatological treatments offer various options to improve their appearance. From topical treatments and chemical peels to advanced laser therapies and surgical interventions, multiple approaches can be tailored to the individual’s needs and skin type. Consulting with an expert dermatologist is crucial to developing an effective, personalized treatment plan. With the right approach, individuals can significantly reduce the appearance of pitted scars and achieve smoother, more even skin.