The benefits of using tretinoin for treating pitted acne scars

When it comes to treating acne and reducing the signs of aging, tretinoin is a superstar. But did you know it may also help reduce the appearance of certain scars caused by acne? Thanks to its collagen-boosting properties that boost the skin’s natural turnover rate, this prescription retinoid helps smooth the skin’s surface for an even-textured appearance. But tretinoin can be irritating (especially at first), so knowing how it works and how to use it correctly is key. 

Here we’ll explain the different types of acne scarring and how tretinoin may help reduce the appearance of some of them. Using tretinoin for pitted acne scars may not be your best choice, but we’ll share some suggestions for treating those as well.

What are pitted acne scars?

Pitted acne scars (aka atrophic scars) have a concave appearance that happens because of a loss of collagen in the skin.¹ There are three types of atrophic scars: icepick, boxcar, and rolling.² Here’s what you need to know about each: 

• Icepickscars are narrow, deep scars with steep, V-shaped edges. They look like small holes in the skin’s surface and are the most common type of atrophic scars.  

• Boxcarscars are U-shaped or crater-like depressions that can be shallow or deep with sharp edges. Skin resurfacing treatments can effectively reduce the appearance of boxcar scars (more on those in a bit).

• Rollingscars are wide but shallow, and their edges are rounded and irregular. Treating rolling scars often requires procedures that penetrate deeper within the skin. 

What is tretinoin? How does it work? 

Tretinoin has been around for decades. It was first used in the 1970s to help reduce the signs of aging, but researchers later discovered it also has acne-fighting benefits.³ Retinoids (like adapalene and tretinoin) increase skin cell turnover to boost the natural exfoliation process. As far as scars go, tretinoin may help prevent them from happening by treating acne and helping prevent new breakouts. Using tretinoin over time may also reduce the appearance of acne scars as it promotes collagen production to give skin a smoother, even texture.⁴ In other words, tretinoin can act as a collagen-boosting cream for pitted scars—but this process can take a very long time and it’s not a guaranteed result. Remember, patience is key, and tretinoin isn’t a miracle product for pitted scars.

Is there a difference between tretinoin and retinol?

Retinol and tretinoin are both topical retinoids, which are vitamin A derivatives. But there are some differences between the two. Retinol is available over the counter, but tretinoin is only available by prescription. Here are some of the other differences between the two:

Retinol  

• It’s available over the counter, but it’s generally not as powerful as tretinoin. Retinol is proven to treat signs of aging, not acne.  

• It tends to be a little easier on sensitive skin. It can still take time for your skin to adjust, so follow the same recommendations as adjusting to tretinoin (see below).

• There are plenty of products with retinol to choose from. If one doesn’t work, try another. 

Tretinoin

• Tretinoin is only available with a prescription from a dermatologist or licensed dermatology provider.

• It’s stronger than retinol and generally works faster and more efficiently. But it can take longer to ease into using products with tretinoin, so go slowly and give your skin time to adjust. If you’re already using retinol, you may be able to transition to tretinoin more easily. 

• Tretinoin is used to treat acne and signs of aging. It’s may be up to 20 times stronger than retinol, although more research is needed.⁵ Using tretinoin for old scars may be effective in reducing their appearance over time. 

How to use tretinoin?

Tretinoin can be a lifesaver when it comes to acne and anti-aging. It’s one of the more prescribed topical treatments by dermatologists. But it can take time for your skin to adjust, so here are some tips to ease tretinoin into your skincare routine.

1. Start with a clean face. This goes for any topical treatment—make sure to wash your face first using a gentle cleanser.

2. Use tretinoin at night and start slowly. A pea-sized amount is all you need to cover your face and neck. If you have more sensitive skin, consider starting by applying tretinoin two to three times a week and gradually increasing the usage as your skin adjusts. 

3. Buffer tretinoin with moisturizer. Apply a moisturizer before tretinoin if you notice dryness or irritation, and continue this layering technique until your skin gets used to the new ingredient. After a while, you’ll be able to switch the order: cleanse, treat, moisturize. Just give your skin some time.

4. Wear sunscreen daily. Tretinoin may cause your skin to be more sensitive to the sun. Use broad-spectrum sunscreen with at least SPF 30 daily as the last step in your morning skincare routine.

Tretinoin’s potential side effects

Tretinoin takes some getting used to, and there are some things you should avoid as your skin adjusts, like waxing your brows or other facial hair. It’s also possible you may experience some side effects as your skin adjusts, including:⁶ 

• Burning, stinging, and itching 

• Unusual dryness 

• Peeling at the application area 

• Redness

Side effects are temporary in most instances. But if they don’t clear up or they get worse, talk to your dermatology or healthcare provider.

Acne scars and other treatment options

Treating acne isn’t always easy, but dealing with the possible results of severe acne—scarring, roughness, and other skin imperfections—can be downright challenging. That’s why the easiest way to avoid scars is to prevent them from happening in the first place by dedicating yourself to a regular skincare routine! 

That said, if you already have acne scarring, we feel you. Thankfully, there are ways to smooth over their appearance, but tretinoin for hypertrophic scars or surgical scars isn’t typically the best option. Acne scars are technically permanent and can require a multifaceted approach, combining topical skincare and in-office procedures to reduce their appearance. 

Treating acne scars with tretinoin 

While tretinoin may potentially improve the appearance of acne scars, it’s important to note that depressed scarring (e.g., boxcar, icepick and rolling scars) does not go away with topical treatments. So while tretinoin may help scarring in the long run, don’t expect any overnight miracles but rather subtle changes to the texture of your skin over a longer period.

If you have acne scarring, here are some more effective procedures your dermatology provider may recommend to help reduce the appearance of acne scars (or eliminate them altogether): 

• Microneedling uses a roller of fine, sharp needles to puncture the skin repeatedly to stimulate collagen production and increase elastin fibers.⁷ 

• Laser treatment includes non-ablative and ablative lasers. Non-ablative lasers stimulate collagen production and ablative lasers remove damaged tissue.⁸

• Dermabrasion and microdermabrasion are techniques used to treat scarring and changes in pigmentation by “sanding” the skin. Dermabrasion removes the top skin layer to encourage new collagen growth. Microdermabrasion is a superficial treatment designed to accelerate the natural exfoliation process.

• Injectables or fillers, like hyaluronic acid, “plump” the skin to reduce the appearance of acne scarring.⁹ As a bonus, injectables can also treat lines and wrinkles.

Personalized skincare with Curology

Curology helps take the guesswork out of your skincare routine—licensed dermatology providers work with you to examine your skin, assess your skincare goals, and provide custom treatment options. Our mission is to make prescription skincare designed for your unique skin accessible to everyone.

While we can’t guarantee you’ll be prescribed tretinoin—it depends on your skin and medical history—you will receive professional recommendations from our in-house licensed dermatology providers. Getting started is as simple as answering a few questions and uploading some selfies. You’ll be paired with one of our dermatology providers, who will be with you every step of the way. Get 25% off your first month by signing up today.*

P.S. We did the homework so you don’t have to:

1. Fife, D. Practical evaluation and management of atrophic acne scars.Journal of Clinical and aesthetic Dermatology. (August 2011).

2. Connolly, D., et al. Acne scarring—Pathogenesis, evaluation, and treatment options.Journal of Clinical and aesthetic Dermatology. (2017 September 1). 

3. Baldwin HE, Nighland M, et al. 40 years of topical tretinoin use in review. J Drugs Dermatol. (2013 June 1).

4. Mukherjee S., et al. Retinoids in the treatment of skin aging: An overview of clinical efficacy and safety.Clinical Interventions in Aging. (December 2006).

5. Mukherjee S, et al. Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety. Ibid.

6. Baldwin HE, Nighland M, et al. 40 years of topical tretinoin use in review. Ibid.

7. Connolly D, Vu HL, et al. Acne Scarring-Pathogenesis, Evaluation, and Treatment Options. Ibid.

8. Fabbrocini, G., et al. Acne scars: Pathogenesis, classification, and treatment.Dermatology Research and Practice. (2010).

9. Fife D. Practical evaluation and management of atrophic acne scars: tips for the general dermatologist. J Clin Aesthet Dermatol. (August 2011). 

Nicole Hangsterfer is a licensed physician assistant at Curology. She obtained her masters in physician assistant studies at the Feinberg School of Medicine at Northwestern in Chicago, IL.

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Written by

Curology Team

Medically reviewed by

Nicole Hangsterfer, PA-C