Pockmarks which are commonly referred to as acne scars are concave shaped indentations on the skin surface that are mostly seen on the cheeks. They occur when the deep layers of the skin get damaged. During the process of healing of these damaged skin layers collagen is produced by the body. It is the collagen which leaves behind scar tissues which look like discolored indentations. Due to this color difference between the scar tissue and the rest of the skin, Pockmarks are highly noticeable and may look unsightly especially if they occur in the facial region.
Just a little patch of Pockmarks can dent the self-confidence of an individual significantly. Acne occurs in about 90% of teenagers and youngsters which may go well into adulthood in about 10% of those, causing psychological distress. There are various treatment options available for Pockmarks but the psychological impact that they have on the affected individual takes a toll on the social and professional life of the individual.
Pockmarks are of two types namely atrophic and hypertrophic. The actual development of the disease process is something which is still being researched but there are several theories that have been proposed. The primary mode of treatments for Pockmarks includes chemical peeling, dermabrasion, laser treatments, and microneedling to name a few.
For hypertrophic scars, surgery is usually recommended along with cryotherapy and steroids. This article highlights in detail the causes for Pockmarks and ways to manage the condition.
What Causes Pockmarks?
The potential causes for Pockmarks include:
Acne: This is perhaps the most common cause of Pockmarks. This is the reason why it has been given the name of acne scars. People tend to develop acne as a result of hormonal changes that occur during the time of puberty. It is this time when the skin starts producing excess of sebum that clogs the skin pores resulting in development of pimples.
If the individual pops these pimples by fingers it leaves a scar. These scars later on turn into Pockmarks. If the acne is severe then also Pockmarks tend to appear even though the affected individual allows the lesions to heal by themselves.
Infectious Causes: Certain infections also cause Pockmarks. Small pox used to be the most common cause for Pockmarks but this infection has been literally eradicated and hence is not an issue at this time. However chicken pox still remains a cause for the development of Pockmarks. They appear when an individual with chicken pox scratches at the lesions which lead to development of scars characteristic of Pockmarks.
There are also certain bacterial infections that also can lead to the development of Pockmarks. Infections caused by staphylococcus and streptococcus bacteria have high likelihood of leaving behind Pockmarks. This usually happens when the infection occurs in the hair follicle resulting in a boil. It may also happen after a cut or a bruise gets infected. 
How are Pockmarks Treated?
Depending on the cause, a treatment plan for Pockmarks is determined. There are a host of options available for individuals with Pockmarks. These include:
Chemical Peel: This is quite an easy and most preferred treatment for managing Pockmarks. This procedure decreases the scarring to a level where they are barely visible. In this procedure, a layer of acid is applied on the affected area. This causes the outer layers of the skin to fall off and allows the skin to regenerate. The new skin will not have the marks like the old one.
On applying acid, the skin may become red or irritated for some time and then shed off. For chemical peels to be effective it is important to get this done on a regular basis; however their efficacy in reducing the Pockmarks cannot be questioned.
Dermabrasion: This procedure is quite similar to chemical peels but it does not use any acid or other chemicals. Instead, a small brush is passed through the affected area which scrapes the damaged skin surface. It generally requires local anesthesia and once done the skin is allowed to regenerate and heal.
This procedure decreases the size of the Pockmarks quite significantly. However, there is some risk associated with this procedure in that the deep layers of the skin are removed which increases the likelihood of infections or development of new Pockmarks.
Microdermabrasion: This procedure is similar to dermabrasion with the only difference being that instead of a brush chemicals are used to scrub the affected area. The most preferred chemicals used for this purpose include bicarbonate crystals and aluminium oxide. This form of treatment is most effective for Pockmarks spread over a small patch of skin. It may require several session of microdermabrasion for best effectiveness.
Dermal Fillers: This procedure involves injecting chemicals like hyaluronic acid to lift the scars and bring it to the level of the rest of the skin. The medication approved to be used as dermal fillers by the FDA in the United States is Bellafill. The efficacy of this treatment however is only temporary and repeat procedure may be required after a few years.
Fractional Laser Treatment: This procedure involves use of laser beams on the affected skin surface to hasten the regeneration process and reduce the scars. The laser burns the top layer of the skin and allows new cells to grow. Once healed, the Pockmarks are hardly visible.
Microneedling: This is a procedure in which small puncture holes are made using a needle and the skin is allowed to heal. Once the healing process starts, there is collagen produced which covers the Pockmarks entirely. This process is done for several sessions and it usually takes about a year for best results to be observed.
Apart from the treatments mentioned above there are also certain home remedies that may reduce the severity of the Pockmarks. These home treatments include:
Natural Oils: There are some natural oils which have a property of decreasing the Pockmarks. These oils contain plenty of antioxidants that help in removing the scar tissue. These oils are also good moisturizers and can be used after cleaning the affected area of the skin.
In some cases, these oil may make the Pockmarks worse and thus these should be tested on a small patch of area first before going for all out application. Some of the natural oils that are useful in treatment of Pockmarks include jojoba oil, hempseed oil, and olive oil to name a few. These oils can be easily obtained at a local pharmacy or herbal stores.
Over-the-counter Creams: There are plenty of over the counter creams and lotions which claim to be quite effective in removing Pockmarks. In fact, these creams are often the first line of treatment for many youngsters with Pockmarks. These creams make the skin moist and calm down the symptoms of itching and erythema over the affected area. 
There are also peels and masks available which can be used over the face to decrease Pockmarks. However, for them to be effective they need to be used for a prolonged period of time. Moreover, there are also chances of side effects which may be unwarranted and thus a consultation with a physician is a must before starting on any over the counter skin product for removing Pockmarks.
Lavender Essential Oil: This is yet another effective home remedy for Pockmarks. Lavender oil itself does not remove Pockmarks but when added with other natural oils mentioned above it hastens the healing process due to its antibacterial and antiinflammatory properties. However, research is still ongoing to identify whether lavender oil is potent enough to remove Pockmarks by itself.
In conclusion, Pockmarks in medical terms is named as acne scars and affects mostly youngsters however adults may also get it at times. The pathogenesis of this condition is still now known but the most common cause of it is believed to be acne. There are a host of treatments available for Pockmarks but the efficacy of these treatments depends varies from individual to individual.[1, 2]
Some people may notice improvements with just a few sessions while some may take a lot longer to observe diminution in Pockmarks. It is thus recommended to consult with a skin specialist to formulate a treatment plan that best suits the individual to manage and hopefully get rid of Pockmarks.[1, 2]