Dimpled Skin: What It Is, Why It Happens, and How to Manage It

What is Dimpled Skin?

Dimpled skin refers to areas of the body where the surface appears pitted, indented, or “scooped out.” The dimples can be shallow or deep, isolated or widespread, and may be present at birth or develop later in life. While a few superficial dimples are harmless (for example, the small pits on the cheeks of many people), multiple or newly‑appearing dimples can signal an underlying dermatologic or systemic condition.

In medical terminology, dimpled skin is often described as pitted epidermis, atrophic scarring, or reticulate depressions. The appearance is caused by loss or thinning of dermal collagen, abnormal fat distribution, or disruption of the skin’s structural architecture.

Common Causes

Below are the most frequently encountered conditions that produce a dimpled or pitted skin texture. Some are purely dermatologic, while others reflect systemic disease.

• Atopic Dermatitis (Eczema) – Chronic scratching leads to lichenification and “pitted” scar‑like depressions, especially on the forearms and shins.
• Acne Scarring – Severe inflammatory acne can destroy collagen, leaving ice‑pick or box‑car (pitted) scars.
• Cutaneous Lupus Erythematosus – Chronic lesions may heal with atrophic, dimpled scars, particularly on the face and scalp.
• Dermatomyositis – The characteristic “Gottron’s papules” may become atrophic and dimpled after inflammation subsides.
• Granuloma Annulare – Annular plaques sometimes develop a central atrophic, dimpled area as they resolve.
• Necrobiosis Lipoidica – Often associated with diabetes, yellow‑brown plaques on the shins can become atrophic with a “telangiectatic” and dimpled surface.
• Hidradenitis Suppurativa (HS) – Chronic sinus tracts heal with puckered, pitted scars in intertriginous zones.
• Connective‑tissue disorders (e.g., Scleroderma) – Skin tightening may be interspersed with indented “pseudocoloboma”‑type depressions.
• Localized lipodystrophy – Loss of subcutaneous fat (often from repeated injections) creates depressed “dimple” patches.
• Genetic skin disorders – Conditions such as Dystrophic Epidermolysis Bullosa or Kindler syndrome can leave pitted, atrophic scars after blistering.

Associated Symptoms

Depending on the underlying cause, dimpled skin may be accompanied by one or more of the following signs:

• Itching or burning sensation
• Redness, warmth, or swelling around the dimples
• Discharge or crusting (common with acne or HS)
• Pain or tenderness, especially if the area is inflamed
• Changes in skin color – hyperpigmentation or hypopigmentation
• Systemic symptoms such as fever, fatigue, joint pain (possible in lupus or dermatomyositis)
• Visible blood vessels (telangiectasia) especially in necrobiosis lipoidica
• Scarring that becomes raised (keloidal) or remains depressed

When to See a Doctor

While occasional, mild dimpling may be cosmetic, you should schedule an appointment if you notice any of the following:

• Rapidly expanding or new dimples without an obvious injury
• Accompanying pain, warmth, or drainage suggesting infection
• Systemic symptoms (fever, unexplained weight loss, joint pain)
• Signs of an autoimmune disease (butterfly rash, muscle weakness)
• Dimples that interfere with daily activities (e.g., on hands, feet, or joints)
• History of chronic skin conditions (acne, eczema) that are not responding to usual treatments

Early evaluation helps prevent permanent scarring and identifies potentially serious underlying illnesses.

Diagnosis

Physicians use a combination of history, visual examination, and targeted tests to determine why the skin is dimpled.

Clinical Assessment

• History – Onset, progression, triggers (e.g., scratching, trauma), personal or family history of skin disease, systemic illnesses.
• Physical exam – Distribution, depth, size, and texture of dimples; presence of erythema, scaling, or ulceration.

Diagnostic Tests

• Dermatoscopy – Handheld magnification to look for vascular patterns that can hint at specific disorders (e.g., lupus).
• Skin biopsy – Small sample examined under a microscope; essential for differentiating inflammatory versus infectious causes.
• Blood work – ANA, anti‑dsDNA (lupus), CK (dermatomyositis), fasting glucose & HbA1c (necrobiosis lipoidica), CBC, ESR/CRP for inflammation.
• Culture – If drainage is present, a bacterial or fungal culture guides antibiotic or antifungal therapy.
• Imaging – Ultrasound or MRI may be used in deep HS tracts or when underlying deeper structures are suspected.

Reference: Mayo Clinic. “Skin biopsy: What to expect.” https://www.mayoclinic.org.

Treatment Options

Treatment is tailored to the root cause and the severity of the dimpling. Below are the most common therapeutic avenues.

Medical Therapies

• Topical corticosteroids – Reduce inflammation in eczema, lupus, or psoriasis‑related dimpling.
• Topical retinoids (tretinoin, adapalene) – Promote collagen remodeling for acne scars.
• Intralesional steroids – Injected directly into hypertrophic or atrophic scars to flatten them.
• Systemic immunosuppressants – Hydroxychloroquine for cutaneous lupus; methotrexate or mycophenolate for severe dermatomyositis.
• Antibiotics – Oral tetracyclines for inflammatory acne; clindamycin + rifampin regimen for hidradenitis suppurativa.
• Biologic agents – Adalimumab (Humira) approved for moderate‑to‑severe hidradenitis suppurativa; also used off‑label for severe psoriasis‑related dimpling.
• Laser & light therapies – Fractional CO₂ laser or pulsed dye laser can improve atrophic scars and vascular components.
• Platelet‑rich plasma (PRP) or microneedling – Stimulate collagen production for acne or surgical scar dimpling.

Home & Lifestyle Measures

• Gentle skin cleansing with pH‑balanced cleansers; avoid harsh scrubbing.
• Moisturize daily with fragrance‑free emollients to improve barrier function.
• Apply silicone gel sheets or silicone oil for scar remodeling (evidence‑based for hypertrophic and atrophic scars).
• Use broad‑spectrum sunscreen (SPF 30 or higher) – UV exposure worsens pigment changes and collagen breakdown.
• Maintain a balanced diet rich in Vitamin C, zinc, and omega‑3 fatty acids, which support skin healing.
• Stop smoking – nicotine impairs fibroblast activity and delays scar maturation.
• For HS, wear loose, breathable clothing and keep intertriginous areas dry.

Prevention Tips

While some causes (genetics, autoimmune disease) cannot be prevented, many modifiable factors can reduce the risk of developing dimpled skin.

• Control chronic skin inflammation – Treat eczema, psoriasis, and acne promptly to prevent scarring.
• Avoid picking or squeezing lesions – Mechanical trauma accelerates collagen loss.
• Practice proper injection technique – Rotate sites and use small‑gauge needles to limit localized lipodystrophy.
• Manage diabetes effectively – Good glycemic control lowers the risk of necrobiosis lipoidica.
• Regular dermatology follow‑up – Early detection of lupus, dermatomyositis, or other systemic diseases allows timely therapy.
• Maintain healthy weight – Obesity can exacerbate hidradenitis suppurativa.
• Skin protection – Use protective clothing during activities that cause friction or pressure on vulnerable areas.

Emergency Warning Signs