Yep, You Actually Can Improve Your Pockmarks
Sometimes, the aftermath of a skin issue can be as frustrating as the issue itself—and that's especially true for anyone who has ever dealt with pockmarks. Ugh. If you've had a past acne breakout and now have indented acne scars or divots to show for it, you're probably already familiar with this skincare saga. And if you're not, welp, this is still relevant to you, because any inflammatory pimple has the potential to leave you with a pockmark.
So whether you're someone who already has pockmarks and are looking to improve them, or you're just someone who wants to avoid them in the future, we've gotchu covered with help from Rachel Maiman, MD, cosmetic and general dermatologist at Marmur Medical. Keep reading to find out exactly what pockmarks are, how to prevent them, and the best treatment options to try. And since early intervention is key, you better get to scrollin' already.
What is the meaning of pockmarks?
According to Dr. Maiman, the term "pockmark" describes a hallow, indented scar on the skin that's caused by a sudden loss of collagen as a result of inflammation. While conditions like chickenpox are sometimes the culprit, acne is the most common cause for pockmarks, which is why they're also referred to as pitted acne scars.
Now, take a look at your skin. You might notice that your pockmarks vary in size and appearance. That, my friend, is because there are multiple kinds of pitted acne scars. Yay! We love skin! Here's the breakdown, according to dr. Maiman:
Three main types of pockmarks
ice pick scars (small, narrow, and deep, like a toothpick made the hole)
boxcar scars (broad, sunken depressions with well-defined edges)
rolling scars (similar to boxcar scars, but smoother and shallower, making the skin surface look uneven and "rolling")
All pockmark scars are caused by collagen damage from inflammation (cystic acne will always run the risk of resulting in pockmarks and pitted scars, FWIW), which brings us to...
How do you prevent pockmarks?
Dr. Maiman says the absolute best way to prevent pitted scarring is early intervention—i.e., treat the problem that's causing it, like acne. So if you're drugstore topicals aren't working, it's truly critical to seek out the evaluation of a board-certified dermatologist to get help. "The reason this is so important is that delay in treatment is perhaps the largest contributing factor to the development of scars," Dr. Maiman says.
Now that you're hopefully getting your butt to the dermatologist, stop yourself from picking, scratching, or squeezing spots on your face in the meantime. Dr. Maiman stresses that this is never a good idea, no matter what, but especially for inflammatory lesions that manifest as cysts and nodules. "Picking at your acne can force debris deeper into the dermis, spreading an infection to other tissue and worsening inflammation and scarring."
And lastly, stay out of the sun and wear sunscreen (you knew it was coming). Diligent sun protection is important, people! Dr. Maiman says the same way that inflammation triggers collagen breakdown, so, too, does UV radiation.
Are pockmarks permanent or can you get rid of them?
Pitted scars are, by definition, scars, so they're permanent. These types of scars can rarely be resolved entirely, which is why it's so critical to prevent scarring before it occurs. That said, you've got plenty of options for improving indented scarring with some pretty impressive results. Here's how:
How do you fill in pitted acne scars?
If you've got very shallow indented scars, topical treatments might help a bit, but in-office treatments with a dermatologist are most effective for pockmarks. And, as Dr. Maiman points out, sometimes a combination of treatments will give you the best results. Below, all the best treatment options, both at-home and in-office.
At-home treatments for pockmarks:
Retinol: Your best bet, according to Dr. Maiman, is to choose active ingredients known to stimulate collagen production, like retinol, to reverse the collagen deficiency that creates the appearance of those scars.
Alpha hydroxy acids: Other effective collagen-stimulating ingredients found over the counter are alpha-hydroxy acids (aka AHAs), such as glycolic acid, which helps exfoliate skin to churn out fresher, brighter, plumper skin.
Vitamin C: Dr. Maiman says vitamin C is also a great addition to your daily routine, since it helps boost collagen production to help smooth scars over time.
Dermarolling: At-home dermarolling is never going to be the best option (you should be seeing a derm for that). But, Dr. Maiman says it can be somewhat effective at home once a week, if you use a simple handheld roller that contains 0.25-millimeter needles. The only caveat? You can't be breaking out. Otherwise, dermarolling can worsen both inflammatory acne and its scarring, making this whole situation worse.
In-office treatments for pockmarks:
Prescription retinoids: A step up from your OTC retinol would be a prescription retinoid, which could give you even better results.
Microneedling with radiofrequency: One of Dr. Maiman's favorite treatment methods for indented scarring, microneedling superficially "injures" your skin to stimulate a repair response in your body that increases collagen production and improves scar appearance. When combined with radiofrequency, it becomes a bit more aggressive, with energy being released deeper within the skin to trigger a bigger inflammatory and collagen response (which is good).
Laser: Fractionated non-ablative and ablative resurfacing lasers are also excellent options. These types of lasers create micro-columns of destruction in your skin in order to encourage new collagen growth. Yup, these tend to hurt a bit, but they're a tried-and-true treatment for pockmarks.
Chemical peels: Although Dr. Maiman argues chemical peels are less effective than device-based treatments, they can still be helpful for exposing fresh, healthy tissue and stimulating the production of new collagen to make pitted scars look less pronounced.
Surgical scar revision: Don't like your scar? Your doctor can essentially remake it with a procedure that involves actually excising the scar and suturing the opposing, normal skin together (though this is best for one-off pockmarks, instead of full-face indents).
Subcision: With this procedure, Dr. Maimain says your doctor can break up the cord of scar tissue that's tethering the skin down and making a depression in the skin.
Others: Dermabrasion, dermal filler injections—the list goes on. Your doctor will be able to figure out which treatment would be the best for your specific case. The point here is that you have plen-ty of options for treating your pockmarks, K?
The takeaway:
The best way to prevent pockmarks is by getting a dermatologist involved early on in your skin journey. A delay in professional treatment = scars. Simple as that. And the same goes for those who already have pockmarks. As Dr. Maiman explains it, your skin’s ability to produce new collagen wanes as you age, which only makes it more difficult to respond to collagen-stimulating treatments, topical or otherwise. The sooner you can see a dermatologist for treatment, the better your results will be. End of story.
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