When people search for “holes in your skin,” they are usually describing a visible textural irregularity: permanent tissue indentations or temporary enlargement of follicular openings. This description encompasses issues ranging from the lasting aftermath of severe inflammation to cosmetic concerns related to aging and oil production. Understanding the specific cause of the depression is necessary because each type requires a completely different approach for management. The following sections will distinguish between these common causes, detailing their formation and the methods available to address them.
Pitted Skin: Identifying Atrophic Scarring
The most common cause of permanent depressions in the skin is atrophic scarring, which follows intense skin inflammation, such as severe acne or chickenpox. Atrophic scars form due to a net loss of underlying tissue, specifically a reduction in collagen and elastic fibers within the dermis. This lack of structural protein causes the skin surface to sink below the level of the surrounding healthy tissue, creating the visible indentation. The inflammatory process leads to the excessive degradation of the supportive dermal structure, resulting in the depressed appearance of atrophic scars.
These scars are classified into three primary subtypes based on their shape and depth, which informs the appropriate treatment strategy.
Icepick Scars
Icepick scars are deep, narrow, V-shaped indentations that resemble small punctures. They are often wider at the surface and taper sharply as they extend into the dermis. Due to their narrow and profound structure, they are often the most challenging type of scar to treat with standard skin resurfacing techniques.
Boxcar Scars
Boxcar scars are broader, round or oval depressions characterized by sharp, vertically defined edges. They are similar to the scars left by resolved chickenpox lesions. These scars vary in depth and are often found on areas of the face where the skin is thicker, such as the jawline and lower cheeks.
Rolling Scars
Rolling scars are broad, wave-like depressions with sloping edges that give the skin an uneven, undulating texture. They are formed when fibrous bands of tissue beneath the skin tether the dermis to the underlying subcutaneous layer. This tethering effect creates an irregular contour that becomes more noticeable as the skin loses its natural elasticity over time.
Visible Pores: Causes of Enlarged Follicular Openings
A separate, non-scarring textural issue often mistaken for small holes is the appearance of enlarged pores, which are the openings of hair follicles. Pores allow the skin to release its natural oil, known as sebum, onto the surface. While size is largely determined by genetics, several factors can exacerbate their visible appearance.
The primary factor contributing to pore size is the volume of sebum produced by the sebaceous glands. Oilier skin types often have more noticeable pores because the excess sebum stretches the follicular opening. Pores also become congested with a mixture of sebum, dead skin cells, and debris, which stretches the pore wall outward. This accumulation makes the opening appear temporarily larger until the blockage is cleared.
Aging and environmental exposure significantly impact pore visibility by compromising the skin’s supportive structure. As the skin matures, it loses collagen and elastin, the proteins responsible for firmness. This loss of support causes the skin surrounding the hair follicle to lose tension and sag, making the pore opening appear wider and more elongated. Chronic sun exposure accelerates this process by breaking down existing collagen and elastin fibers. Sun protection is therefore a straightforward way to maintain pore structure integrity and minimize their appearance.
Specific Medical Conditions Causing Indentations
While most pits relate to acne scarring or visible pores, certain less common medical conditions also result in a pitted appearance. These diagnoses are distinct from typical facial concerns and require medical confirmation.
Pitted Keratolysis (PK)
Pitted Keratolysis is a superficial bacterial skin infection characterized by small, shallow, crater-like pits, typically one to three millimeters in size, found almost exclusively on the soles of the feet. The condition is caused by bacteria, such as Kytococcus sedentarius, which thrive in warm, moist environments created by excessive sweating (hyperhidrosis) and occlusive footwear. These bacteria produce enzymes that degrade the skin’s outermost layer, resulting in the characteristic pits and often a noticeable odor.
Keratosis Pilaris (KP)
Keratosis Pilaris is a common, benign genetic condition that presents as numerous tiny, rough bumps around hair follicles. KP is caused by the accumulation of excess keratin protein that forms a plug within the hair follicle opening. These small, painless bumps typically appear on the outer sides of the upper arms, thighs, or buttocks, giving the skin a sandpaper texture.
Professional Correction and Management Options
Addressing textural irregularities requires a tailored approach that distinguishes between permanent tissue loss (scarring) and structural issues (pore visibility).
Treatment for Atrophic Scarring
The goal of professional correction for scarring is to stimulate new collagen production to raise the depressed tissue. Minimally invasive procedures like microneedling, also known as collagen induction therapy, create controlled micro-injuries in the dermis. This triggers the body’s natural wound healing cascade, resulting in the increased synthesis of dermal collagen and elastin, which helps to remodel and elevate the scar tissue.
Fractional laser resurfacing is another effective method, using targeted energy to remove microscopic columns of scarred tissue while stimulating surrounding cells to produce new, healthy collagen. For deep rolling scars where fibrous bands pull the skin downward, a procedure called subcision may be performed to physically break these tethers, allowing the skin to lift and smooth out. Chemical peels, particularly medium to deep strength peels, can also be utilized to exfoliate damaged layers of skin and encourage the remodeling of collagen, especially in the case of boxcar scars.
Management of Enlarged Pores
Management of enlarged pores focuses primarily on controlling sebum production and improving skin elasticity. Topical retinoids, derivatives of Vitamin A, are effective because they increase the rate of cell turnover, preventing the buildup of dead cells that can stretch the pore opening. Retinoids also help to regulate the activity of the oil glands, reducing overall sebum flow.
Salicylic acid (a beta hydroxy acid or BHA) works by penetrating deep into the pore lining to dissolve the mixture of oil and debris clogging it. This deep cleansing action reduces congestion and makes the pore opening appear less prominent. Another element is Niacinamide (Vitamin B3), which further aids in reducing pore appearance by regulating sebum production and improving the skin’s barrier function. This improved barrier contributes to increased elasticity around the pore walls. Consulting with a dermatologist is necessary to establish an individualized plan that combines these advanced home care ingredients with appropriate in-office treatments.