ISLAMABAD: Pockmarks are deep scars on the skin that do not usually go away on their own. They are often caused by severe acne but can also be the result of skin infections or chickenpox.

There are a number of treatments and home remedies that may help reduce the appearance of the scars and improve the look and feel of the skin.

In this article, we outline some of the different causes of pockmarks and the various ways to treat them.

What are pockmarks?
 Pockmarks may look like indentations in the skin and occur because of damage to deeper skin layers.

Pockmarks, which are also called pick marks or acne scars, are blemishes with a concave shape that can look like holes or indentations in the skin. They occur when the deeper layers of the skin become damaged.

As these deeper layers heal, extra collagen is produced. This extra collagen can leave behind scar tissue that does not match the rest of the skin.

Pockmarks tend to stick out from the rest of the skin and be noticeable. Even a few of them may give the skin an uneven look, which can make some people self-conscious.

Causes
Disorders or diseases that cause blemishes on the skin all have the potential to cause pockmark scars.

Acne
One of the more common causes of pockmarks is acne. Acne is a common occurrence for most people, especially during the hormonal changes that come with puberty.

The skin may produce extra sebum during this time, which clogs the pores and causes zits and pimples. Popping zits and pimples may lead to pockmark scars later on.

Severe cases of acne may also cause pockmarks, even if a person lets the acne heal on its own.

Infectious diseases
Infectious diseases, including smallpox, used to be a common cause for pockmarks.

Although smallpox has mostly disappeared, similar issues, such as chickenpox, may also cause the characteristic scars.

Chickenpox causes small itchy blisters that show up all over the body. Scratching the scabs before they heal completely can leave a pockmark.

Treatment
There are several treatments for pockmarks, each with varying results. Certain skin types may be less able to tolerate some treatments, so a person should discuss their options with a doctor.

Chemical peel
Regular chemical peels may help to reduce scarring.

Many people with pockmarks choose to undergo a chemical peel to reduce the scarring. During a chemical peel, a layer of acid is applied to the face. An enzyme may also be used to produce similar results.

These treatments remove the outer layers of skin and cause it to regenerate. The skin can be red and irritated after the peel and may shed.

Chemical peels may need to be done on a regular basis to be effective, but they usually result in even, supple skin, and a noticeable reduction in visible pockmarks.

Dermabrasion
Dermabrasion sessions achieve similar results as chemical peels without using chemicals. A small, rotating wire brush is passed over the affected skin to scrape away the top layers.
This dermabrasion or scraping is done either under local or general anesthesia,

depending on the size of the area that needs treatment. The skin is then left to heal.
Dermabrasion can help create a more even look to the skin and reduce the signs of pockmarks.

In some cases, dermabrasion may increase the risk of creating new scars or enlarged pores. Because deeper layers of the dermis are removed, it may also put a person at risk for skin infections.

Microdermabrasion
Microdermabrasion treatments again aim to reduce pockmarks by removing the outermost layers of skin.

Instead of using a chemical or wire brush for this process, skin care specialists will use abrasive ingredients, such as tiny crystals of bicarbonate or aluminum oxide to scrub away the outer layers of skin. This works best for small surface scars and often requires several treatments.

Dermal fillers
Doctors may also recommend facial fillers to treat pockmarks. These are injections of products that lift the pockmarks to the level of the rest of the skin on the face.

There are various products on the market, including hyaluronic acids and calcium hydroxylapatite that may be used.

The United States Food and Drug Administration (FDA) has only approved Bellafill for the treatment of acne scars. This product has tiny polymethyl methacrylate (PMMA) microspheres within a smooth collagen gel base.

The effect of dermal fillers is temporary but usually lasts from a few months to a year, depending on the product. Bellafill usually lasts 5 years.

Fractional laser
Fractional laser therapy aims to stimulate regeneration in the scars themselves. Laser light is directed onto the scar tissue of the pockmarks.

This burns the outer layer of the scarred skin and stimulates new cell growth. After a period of healing, pockmarks are often noticeably less visible.

Ablative laser resurfacing
Ablative laser resurfacing is an invasive form of laser treatment that removes layers of skin by using a laser. The procedure typically requires a couple of weeks of medical care and recovery, but the results can last for years without any additional treatments.

Ablative laser resurfacing does have some risks, including changes in skin color, redness, and swelling. In some cases, ablative laser therapy can make acne or scarring worse.

Microneedling
Collagen-induction therapy or microneedling is a treatment that involves puncturing the skin, where the pockmark is, using small needles. As these punctures heal, the skin produces more collagen to fill in the pockmarks.

Repeat treatments may be required every few weeks, and significant results are generally visible within a year.

Home remedies
While there is no guarantee that any home treatment will make pockmarks go away, many people find that their scars may be less noticeable with one or more home treatments.
These home treatments can often be found at a health store or in an over-the-counter (OTC) medicine.

Moisturizing oils
Testing oils and butters on a small patch of skin is recommended to avoid adverse reactions.

Some natural oils may also reduce signs of scarring, including pockmarks. These oils often contain natural antioxidants or other compounds that may help reduce scar tissue or help wounds heal.

Oils can be used, as moisturizers, after cleaning the affected skin. Some oils may make acne worse for some people, so it is best to test the oil on a small area of skin before using it regularly.

OTC treatments
OTC creams are often the first treatment method people try to reduce their pockmarks. These creams mainly work by hydrating the skin and easing symptoms, such as itching or redness.

Some low-strength peels and masks may also stimulate new skin growth and help reduce signs of scarring. They often require continuous use over for a long time to produce results.
Continuous use of these chemicals may also cause unwanted side effects, so a person should consult a medical professional before using them.

Facial massage
While it is not a direct remedy for scars, getting a facial massage may help support other treatment methods.

Whether through manual stimulation or with the aid of a massage wand, facial massage may help improve circulation in the skin and remove toxins, which could make other treatments more effective.

Lavender essential oil
Adding a few drops of lavender essential oil to the other oils on the list above may help wounds heal better. Research has noted that lavender essential oil is known to have antibacterial and anti-inflammatory properties, and may even help reduce scar tissue in some people.

More research is needed on humans to see if lavender oil can reduce scar tissue, but it may still help reduce inflammation and bacteria on the skin.