How Hidradenitis Suppurativa Scars Are Treated

What causes hidradenitis suppurativa scars?

Experts believe that symptoms of HS develop when hair follicles under your skin become blocked and burst. This spills bacteria into the inner layer of your skin and causes inflamed, boil-like nodules or lumps to form. These nodules often develop into skin lesions or sores that drain pus and blood.

Sometimes, HS causes open wounds that don’t heal well. In severe cases, the lesions may form tunnels under your skin known as sinus tracks. This can lead to significant scarring that may:

• feel uncomfortable
• change the appearance of your skin
• make it harder to move affected areas

Getting treatment for HS may help limit active symptoms and scarring.

Treatment options

Your recommended treatment for HS will depend on your symptoms, medical history, and in some cases, skin tone.

Your doctor may recommend one or more of the following treatments to reduce active lesions and stop the condition from getting worse:

• lifestyle changes, including proper skin care
• oral or injectable medication
• light or laser therapy
• laser hair removal
• surgery

Following your recommended treatment may help limit the formation of new scars by reducing active lesions.

If you have scars, your doctor may also prescribe one or more of the treatments below to reduce the appearance of scars or remove them altogether.

Intralesional injections

Intralesional corticosteroid injections may help reduce the appearance of keloid scars, which are a specific type of scar that can develop in HS. Not all HS scars are keloid scars.

Injections with one or more of the following medications may also help treat keloid scars:

• triamcinolone acetonide
• 5-fluorouracil
• bleomycin
• interferon

However, more research is needed to learn how these treatments affect keloid scars in people with HS.

CO₂ laser therapy

In 2018 guidelines, an international group of HS experts recommended several treatments for HS that may help treat active lesions and also reduce the appearance of scarring. One of these treatments is carbon dioxide (CO₂) laser therapy, which uses a CO₂ laser to vaporize skin affected by HS.

This treatment causes controlled injuries to your skin, which stimulate healing and collagen production. This helps improve the appearance of scar tissue, although it won’t eliminate scarring altogether.

CO₂ laser therapy may cause post-inflammatory hyperpigmentation (PIH), especially in people with dark skin. PIH causes dark patches of skin that may be permanent or fade with time.

If you’re thinking about getting CO₂ laser therapy, your doctor can help you learn about the potential benefits and risks. It’s important to find a board certified dermatologist who has experience treating your type of skin.

Surgical excision

The 2018 guidelines also recommend surgical excision, which is another treatment that your doctor may use to remove areas of skin that have active lesions as well as scarring.

In this procedure, your doctor will cut away skin that’s affected by HS lesions and scars. They may use limited local excision to remove small areas of skin or wide excision to remove larger areas of skin. They may use sutures to close the excision or a skin graft or skin flap to cover it.

It’s important to follow your doctor’s directions for postsurgery wound care to promote healing and prevent infection. The surgery itself may cause some scarring, which may be worse if you develop an infection.

Other scar treatments

Several other treatments are available for mild to moderate scarring, including:

• Scar tissue massage: Massaging new scars may help limit scar tissue buildup and promote healing. It may also help keep the affected area of skin flexible.
• Topical treatments: Some over-the-counter creams or other topical treatments may help reduce the appearance of scarring. Talk with your doctor to learn which products may work well for you.
• Dermabrasion: In dermabrasion or microdermabrasion, a doctor uses a special tool to remove the top layers of your skin. This may help reduce the appearance of scars, but it can cause discoloration of dark skin.
• Microneedling: In micro-needling, a doctor uses thin, sterile needles to puncture your skin, which may help stimulate healing and collagen production to reduce the appearance of scar tissue. Microneedling doesn’t cause discoloration of dark skin.

More research is needed to learn how these treatments affect scarring from HS in particular.

Many people with HS have extensive scarring that may require more aggressive treatment.

If you’re interested in trying dermabrasion or micro-needling, look for a board certified dermatologist to provide the treatment. Some forms of these treatments are also available at non-medical spas or with at-home devices, but these options may not be as safe or effective as treatments provided by a dermatologist.

Mental health and social support

In addition to treating HS lesions and scars, it’s also important to recognize and manage the effects that HS may have on your psychosocial well-being.

A 2017 study found some people with HS avoid activities such as swimming or sex because they feel self-conscious about other people seeing their lesions or scars.

According to a 2020 review, HS is also linked to an increased risk of mental health conditions such as depression and anxiety.

If you suspect that HS may be negatively affecting your self-image, social wellness, or mental health, consider asking your doctor for a referral to a mental health professional who has experience treating people with chronic skin conditions. They can help you develop coping strategies to manage the psychosocial effects of this condition.

You might also find it helpful to join a support group for people with HS. One example is Hope for HS, a nonprofit organization that operates multiple online and in-person support groups in the United States.

What do hidradenitis suppurativa scars look like?

HS can cause multiple types of scars, including:

• hyperpigmented scars, which look darker than the surrounding skin
• hypopigmented scars, which look lighter than the surrounding skin
• erythematous scars, which are pink, red, or purple in tone
• atrophic scars, which are indented
• hypertrophic scars, which are thick and raised
• keloids, which may include both active lesions and scar tissue

The appearance of the scars may vary across skin tones. For example, erythematous scars may appear pinkish on light skin but purplish on dark skin.

KS lesions and scars are most likely to form on areas of your body where skin rubs together, such as your:

• armpits
• breasts
• groin
• buttocks

People with severe HS often develop tracts of scar tissue or thick rope-like scars that crisscross affected skin.

Is scarring preventable?

The best way to manage HS scars is to prevent them from forming in the first place.

It may be challenging to avoid scarring altogether, but you can limit the severity of scarring by following your doctor’s recommended treatment plan for HS.

Getting treatment for HS can help clear existing lesions and prevent new lesions from forming, which helps prevent the development of new scars.

Let your doctor know if you develop changes in your symptoms or have concerns about your current treatment plan. They may recommend changes to your treatment.

Takeaway

Getting treatment for HS is important for reducing symptoms and preventing the formation of scars. Your doctor may recommend a combination of lifestyle changes, medications, light or laser therapy, or surgery to treat it.

If you develop scars that are negatively affecting your comfort or quality of life, let your doctor know.

Depending on the type and severity of the scar, they may recommend:

• intralesional injections
• CO₂ laser therapy
• surgical excision
• other treatments

They may also refer you to a mental health professional or patient support group to help you manage the psychosocial effects of living with HS.