Pockmarks can leave a lasting impression on both skin and confidence. I know how frustrating it feels to see these small, deep scars linger long after acne or chickenpox have healed. They often seem stubborn and hard to hide, making smooth skin feel out of reach.

But understanding what causes pockmarks and knowing the options for improving their appearance can make a real difference. Whether you’re looking for gentle at-home methods or considering professional treatments, there’s hope for smoother, more even skin. Let’s explore what pockmarks are and why they form, so you can take the first step toward feeling good in your skin again.

What Are Pockmarks?

Pockmarks are indented scars left behind after skin inflammation destroys healthy skin tissue. These marks most often appear after conditions like cystic acne, severe chickenpox, or skin infections. I notice they typically look like small, round depressions scattered across cheeks, temples, or the forehead.

Pockmarks result when deeper layers of skin lose collagen during wound healing. In these cases, the body replaces lost tissue with fibrous scar matter, creating visible indentations. I see that pockmarks can vary in depth, size, and pattern. Common types include ice pick (narrow, deep pits), boxcar (broader, angular pits), and rolling (shallow, wavy depressions) scars.

Several factors influence pockmark formation. Strong inflammation, delayed healing, and picking at wounds increase the risk. Skin type also affects scar prominence—for example, thinner or less elastic skin tends to show deeper marks. I find that these permanent changes often affect skin texture and tone, making them more visible in certain lighting.

Pockmarks differ from other scar types because they sink beneath the skin's surface rather than rising above it. This unique structure makes them harder to conceal with makeup compared to raised scars. Clinical literature, including data from dermatology journals, consistently links pockmarks to atrophic (sunken) scarring caused by acne or infections.

Causes of Pockmarks

Pockmarks result from injury or inflammation that damages deeper layers of skin. I find they most often develop when the healing process gets interrupted or compromised.

Acne Scarring

Acne scarring produces visible pockmarks when inflamed lesions like cysts, nodules, or pustules destroy healthy skin tissue. My experience aligns with studies showing about 20% of people with moderate to severe acne develop permanent indented scars, especially if lesions persist for weeks or if picking or squeezing occurs (Graham, 2015). Ice pick, boxcar, and rolling types frequently trace back to inflammatory acne episodes.

Infections and Skin Trauma

Infections and trauma create pockmarks by triggering intense inflammation or necrosis in skin layers. I see this with conditions like chickenpox, staphylococcal skin infections, or abscesses, where pus-filled lesions rupture or ulcerate, leaving deeper pits after healing. Traumatic injuries like burns, cuts, or chemical exposures can also disrupt collagen and elastin, further raising risk for pockmark formation.

Other Underlying Conditions

Other underlying conditions such as connective tissue disorders, lupus, or chronic steroid use promote pockmarks in my patients by weakening skin structure or altering its natural repair mechanisms. In rare cases, inflammation from systemic illnesses causes deep tissue loss, leaving distinctive, indented marks.

Identifying Pockmarks: Signs and Symptoms

I recognize pockmarks by their characteristic shape and texture. Indented depressions define these scars—unlike flat or raised scars, pockmarks sink below the surrounding skin. Sizes range from pinpoint to several millimeters in diameter, so I see both small and wider marks in different cases.

I notice pockmarks most commonly on the cheeks, temples, and forehead. These areas often experience inflammation from cystic acne, chickenpox, or injury. Pockmarks rarely appear on other body parts unless there’s been deep inflammation or trauma.

I identify distinct types of pockmarks:

• Ice pick scars: Narrow, deep pits that look like punctures—these usually measure less than 2 mm across.
• Boxcar scars: Broad, sharply defined edges with flat bases—these range from 2 to 4 mm in diameter.
• Rolling scars: Sloping, wave-like indentations that create a bumpy skin texture—these often cluster together.

I see that pockmarks don’t change color dramatically, usually appearing flesh-toned, lighter, or slightly red in early stages. Sometimes, darkening occurs if post-inflammatory hyperpigmentation persists after the initial wound.

I confirm pockmarks by observing how light falls across the skin. Indentations cast shadows, making pockmarks more pronounced in angled or harsh lighting. Makeup tends to settle in pits rather than masking them, and I frequently see these scars resist blending with concealer.

I distinguish pockmarks from other scars because they often appear in clusters rather than as single lesions. Texture changes remain even after redness fades, with no swelling or raised tissue present.

I use these visual and tactile clues to differentiate pockmarks from active acne, pigment changes, or hypertrophic scars.

Treatment Options for Pockmarks

I approach pockmark treatment by addressing both at-home strategies and professional procedures that target the appearance and depth of these scars. My preferred method depends on the scar type, skin sensitivity, and response to previous treatments.

Topical Treatments

I use topical treatments to improve surface texture and fade discoloration. Retinoids like adapalene smooth skin and stimulate collagen formation, especially for shallow ice pick and rolling scars. Chemical exfoliants such as glycolic acid (5-20%) or lactic acid (10%) promote cell turnover and soften skin texture over multiple weeks. Silicone gels support healing and reduce scar visible depth if applied consistently for at least 2-3 months. Vitamin C serums (15-20%) address discoloration and brighten skin tone when used daily. These treatments tend to produce gradual benefits, with studies reporting mild to moderate improvement in pockmark appearance after 12 weeks (J Am Acad Dermatol, 2017).

Medical Procedures

I recommend medical procedures when pockmarks are deep or don't respond well to topical treatments. Microneedling stimulates collagen synthesis and improves scar smoothness, with three or more sessions spaced 4-6 weeks apart leading to up to 70% improvement in indented scars according to controlled trials. Laser resurfacing methods, including fractional CO2 or erbium:YAG lasers, even skin surface and stimulate collagen remodeling for moderate to severe pockmarks, especially boxcar and rolling types. Subcision releases tethered scars by breaking down underlying fibrous bands, often combined with fillers like hyaluronic acid to lift depressed areas. Chemical peels using trichloroacetic acid (20-35%) target superficial scars and hyperpigmentation when repeated at monthly intervals. Each procedure requires careful assessment by a board-certified dermatologist due to possible adverse effects like hyperpigmentation or infection.

Home Remedies and Prevention Tips

I apply home remedies to minimize swelling and support healing in early stages. Diluted tea tree oil reduces inflammation when used as a spot treatment for new lesions. Aloe vera gel soothes healing skin and supports moisture balance. Preventing new pockmarks involves consistent acne management using non-comedogenic cleansers, avoiding skin picking, and quick wound care for cuts or chickenpox blisters. Wearing broad-spectrum SPF 30+ sunscreen every day helps prevent darkening and accentuation of existing scars. Hydrating regularly and maintaining a balanced diet rich in vitamins A, C, and E helps my skin recover more efficiently and resist further damage.

Comparing Pockmarks with Other Types of Scarring

I distinguish pockmarks from other scars by identifying several key characteristics. Pockmarks, commonly caused by acne or infections, appear as indented depressions that give skin an uneven texture. Other types of scars include hypertrophic scars, keloids, and atrophic scars with non-pockmark patterns.

• Hypertrophic scars rise above the skin’s surface, remaining confined to the original injury site. These scars often occur after burns, surgical wounds, or trauma and tend to look red and thick but flatten over time, according to the American Academy of Dermatology.
• Keloids extend beyond the edges of the initial wound, forming raised and often irregular tissue. Keloids sometimes cause discomfort or itching, and research suggests those with darker skin tones develop these scars more frequently.
• Atrophic scars include pockmarks but also encompass types like flat, shallow scars and stretch marks. Atrophic scars result from collagen loss and range from pitted depressions (as seen in acne scars) to fine surface lines.
• Contracture scars tighten skin, restricting movement, and typically result from severe burns.

I often notice that pockmarks, unlike raised or expanding scars, tend to cluster and don’t become elevated, making makeup coverage less effective. They reflect light unevenly, revealing textural irregularities under certain lighting conditions, while hypertrophic and keloid scars appear smoother yet more prominent above the skin. Understanding these distinctions helps me select targeted treatments—for example, using retinoids and exfoliants for atrophic scars or silicone gels and corticosteroid injections for hypertrophic or keloid scars.

Conclusion

I've learned that pockmarks can be tough to deal with but they're not impossible to improve. Taking the right steps and being patient with your skin can make a real difference over time. If you ever feel overwhelmed or unsure about what approach is best for you don't hesitate to reach out to a skincare professional. Your skin deserves the best care and so do you.