Can tretinoin fill in pitted acne scars?
Tretinoin will not remove a pitted acne scar. It may slightly improve the appearance of boxcar and rolling scars by stimulating collagen production, however the effect is mild and it will not fill a pit.
Tretinoin is a topical retinoid. It increases the rate at which skin cells renew and, over months of continued use, can stimulate collagen production within the skin. This produces an improvement in fine surface texture, in pigmentation and in overall skin quality. It is also an effective acne treatment, which is important, since controlling active acne is the single most effective means of preventing further scars from forming.
The reason the effect upon dipped scars is limited is structural. A boxcar, rolling or ice pick scar represents a defect within the dermis, in some cases tethered to deeper tissue. The collagen that tretinoin stimulates is superficial and diffuse. It is not laid down preferentially at the base of a scar, and there is insufficient of it to alter the contour of a depression which may be a millimetre or more in depth. Where boxcar and rolling scars are shallow, months of consistent use can soften their edges and render them slightly less obvious. It is not the same as filling a scar, which is what most patients mean when they ask.
The treatments that alter the contour of a scar are subcision where the scar is tethered, TCA CROSS for narrow deep ice pick scars, punch excision where there are a small number of deep scars, and fractional laser resurfacing for shallower pitted scarring and surface irregularity. These address the structure of the scar rather than the surface of the skin above it.
Tretinoin is therefore worth using, but for the right reasons: to control acne, to improve pigmentation and to improve surface quality. It should not be used in the expectation that pitted scars will fill in. Tretinoin is a prescription-only medicine in the United Kingdom and should be prescribed and supervised by a doctor.
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