Pitted skin refers to small depressions or indentations in the skin’s surface, creating an uneven texture that sits below the level of the surrounding skin. These pits form when the deeper layers of skin lose collagen, fat, or other structural tissue, leaving the surface unable to stay level. The most common cause is acne scarring, but chickenpox, injuries, and certain skin conditions can produce similar indentations.
Why Skin Becomes Pitted
The pits themselves are a result of damage beneath the surface. When the skin experiences significant inflammation, whether from a deep pimple, an infection like chickenpox, or a wound, the normal healing process can go wrong. Instead of rebuilding tissue evenly, the body destroys more collagen than it replaces. This net loss of structural support causes the surface to collapse inward, forming a visible depression.
Inflammatory cells are found in about 77 percent of these depressed scars, and in 80 to 90 percent of acne scarring cases, the outcome is a net destruction of collagen rather than an overproduction of it. That’s why acne scars more often appear as pits rather than raised bumps. The deeper and more inflamed the original breakout or injury, the more likely it is to leave behind a permanent indentation.
Three Types of Pitted Scars
Not all skin pits look the same. They generally fall into three categories, and the distinction matters because each responds differently to treatment.
- Ice pick scars are narrow, deep holes that look like the skin was punctured with a sharp instrument. They’re typically less than 2 millimeters wide but can extend deep into the dermis. These are the most difficult to treat.
- Boxcar scars are wider depressions with sharp, defined edges, almost like a small crater. They can be shallow or deep and are common on the cheeks and temples.
- Rolling scars create a wave-like, undulating texture across the skin. They’re caused by bands of scar tissue pulling the surface downward from underneath, giving the skin an uneven, rippled look.
Pitted Skin vs. Pitting Edema
If you searched “pitted skin” because pressing on your skin leaves a temporary dent, that’s a different condition entirely. Pitting edema is a type of swelling where pushing on a swollen area (usually the lower legs, ankles, or feet) creates an indentation that slowly fills back in. It’s caused by fluid retention, not scarring, and can signal heart, kidney, or liver issues. The key difference: pitting edema is temporary and related to swelling, while pitted skin from scarring is a permanent textural change in the skin itself.
Why Pitted Skin Gets Worse With Age
Many people with pitted scars don’t seek treatment until their 30s, 40s, or 50s, not because the scars are new, but because aging makes them more visible. Both scarring and normal aging cause the same types of loss: collagen breaks down, fat beneath the skin shrinks, and elasticity decreases. When facial skin begins to sag naturally, it gets caught on old scar tissue underneath, creating an irregular, cascading appearance that wasn’t as noticeable on younger, fuller skin.
This compounding effect means someone who had manageable acne scars at 25 may find them significantly more prominent at 45, even though no new damage has occurred.
What Topical Products Can and Cannot Do
Over-the-counter products like retinol, glycolic acid, and salicylic acid can improve overall skin texture and tone, but their ability to fill in established pits is limited. Retinoids, the strongest category of topical treatment, require more than six months of consistent use before any measurable new collagen forms in the deeper skin layers. Even then, improvements tend to be modest for true pitted scars. One clinical study found no significant changes in dermal thickness or collagen regeneration after six months of prescription-strength retinoid use. Some improvement appeared at the 12-month mark, but it was subtle.
Retinoids also cause irritation, including burning, scaling, and dermatitis, which leads many people to stop using them before any benefit kicks in. These products work best as a maintenance strategy or for very shallow surface irregularities rather than as a solution for deeper pits.
Professional Treatments That Reshape the Skin
For noticeable pitted scars, in-office procedures offer substantially more improvement than anything available at home. Most people benefit from a combination of approaches tailored to their specific scar types.
Microneedling
This treatment creates hundreds of tiny punctures in the skin to trigger the body’s repair response. The controlled damage stimulates production of new collagen (types I, III, and VII) and elastin, gradually filling in depressed areas from below. Recovery time is short, and the complication rate is low. Microneedling works best on rolling scars, followed by boxcar scars, with more modest results for deep ice pick scars. Multiple sessions are typically needed.
Fractional Laser Resurfacing
Fractional CO2 lasers vaporize tiny columns of skin tissue, prompting aggressive collagen remodeling as the skin heals. A series of four to five monthly treatments can improve scar depth and appearance by up to 50 percent. One study showed scar depth improvements of nearly 67 percent, with continued smoothing visible six months after the final session. This is one of the more effective options for moderate to severe pitting, though it involves more downtime than microneedling.
Subcision
For rolling and boxcar scars specifically, subcision breaks the fibrous bands of scar tissue that pull the skin surface downward. A needle is inserted beneath the scar to release these tethering bands, allowing the skin to rise back to a more level position. Studies using standardized scar grading tools have reported a 100 percent effective improvement rate for rolling scars. Subcision is often combined with microneedling or laser treatments for better results.
Chemical Peels
Chemical peels dissolve the outermost skin cells and promote exfoliation, encouraging new collagen production as the skin regenerates. Shallow peels can improve mild, superficial pitting and uneven pigmentation. For deeper scars, particularly ice pick scars, a technique called CROSS applies a high-concentration acid directly to the base of individual scars using a fine applicator, destroying damaged tissue and triggering rebuilding from the bottom up.
Dermal Fillers
Injectable fillers physically lift depressed scars by adding volume beneath them. Temporary fillers last up to 18 months. Semi-permanent options that also stimulate the body’s own collagen production can last two to three years. A permanent synthetic filler was FDA-approved specifically for moderate to severe pitted acne scars in 2014. Fillers work well for broader, shallower depressions but are less practical for narrow ice pick scars.
Preventing Pitted Scars
The single most effective way to prevent pitted skin is early treatment of active acne or other inflammatory skin conditions. Inflammation is the key factor that determines whether a breakout leaves a scar behind. Deep, inflamed cysts and nodules are far more likely to cause permanent pitting than surface-level whiteheads and blackheads.
Picking, squeezing, or popping pimples dramatically increases the risk of scarring by driving inflammation deeper into the skin and disrupting the healing process. Using a gentle chemical exfoliant with glycolic or salicylic acid, rather than abrasive scrubs, helps keep pores clear without creating additional trauma. Daily oil-free sunscreen protects healing skin from UV damage, which can darken and emphasize developing scars. If over-the-counter acne products aren’t resolving breakouts after a couple of months, prescription treatment can prevent the kind of prolonged inflammation that leads to permanent pitting.