Hidradenitis Suppurativa (HS) is a chronic inflammatory skin condition characterized by painful lumps and abscesses that form under the skin, primarily in areas where skin rubs together like the armpits or groin. These lesions often rupture and heal, leading to various types of scars, including raised scars like keloids and hypertrophic scars, depressed or indented (atrophic) scars, and discolored areas that can be darker (hyperpigmented) or lighter (hypopigmented). Some people also develop tunnel-like tracts beneath the skin that connect lesions, contributing to significant scarring. These scars can affect physical comfort, range of motion, and quality of life. Addressing these scars involves a range of approaches aimed at improving their appearance and alleviating associated discomfort.
Topical and Home-Based Approaches
Non-prescription and over-the-counter options can help improve the appearance of mild to moderate HS scars with consistent use. Topical treatments containing silicone, available as gels or sheets, reduce scar size, pain, itching, and redness, particularly for raised scars. Ingredients such as onion extract, vitamin E, and retinoids like retinol are also found in some scar creams.
Gentle massage of existing scars with an ointment, such as petroleum jelly, can minimize their appearance and decrease the height of raised scars. Massaging new scars may limit scar tissue buildup, promote healing, and keep the skin flexible. Sun protection is important for scars, as sun exposure can worsen their appearance. Maintaining good skin hygiene in affected areas and applying warm compresses to painful lumps can provide comfort and aid in drainage.
Professional Medical Procedures
Laser therapy, particularly carbon dioxide (CO2) lasers, is often recommended for extensive HS scars. CO2 lasers remove small layers of skin with heat, stimulating new collagen production to improve scar texture, color, and thickness. Fractional CO2 laser therapy targets microscopic columns of skin, promoting healing and collagen remodeling. Individuals with darker skin tones should consult a specialist as CO2 lasers can carry a higher risk of post-inflammatory hyperpigmentation.
Injections are a common approach, with corticosteroids like triamcinolone acetonide frequently used for hypertrophic or keloid scars. These injections reduce inflammation and flatten scar tissue. Combining corticosteroids with other injectable medications, such as 5-fluorouracil or bleomycin, may further reduce scar size and prevent recurrence. Dermabrasion and microdermabrasion are exfoliating techniques that improve surface texture, while microneedling stimulates collagen production to enhance scar appearance. These procedures often require multiple sessions and are performed by a healthcare professional to ensure optimal results.
Surgical Options
Surgical interventions are often reserved for more severe or persistent HS scars and require consultation with a surgeon experienced in the condition. Excision involves the surgical removal of individual scars or scar tissue, with the wound then carefully closed. Deroofing is a technique specifically used for tunnels or tracts common in HS. This procedure involves removing the “roof” of the tunnel, allowing the area to heal from the inside out and reducing associated scarring.
For larger areas of scar tissue where direct closure is not feasible, skin grafts or flaps may be necessary. Skin grafting involves transplanting healthy skin from another part of the body to cover the wound, while skin flaps maintain their own blood supply. These methods reconstruct the affected area after scar removal. Surgical options typically involve longer recovery times compared to less invasive procedures.
Preventing Future Scarring
Minimizing future scarring depends on effectively managing active HS and preventing new lesions. Early intervention and consistent medical treatment for HS can significantly reduce flare-ups and lesion formation, which are the primary causes of new scars. Common medical treatments for HS include antibiotics, biologics, retinoids, and hormonal therapies, which control underlying inflammation. Following a doctor’s recommended treatment plan is important to limit the severity of scarring.
Lifestyle modifications also play a role in preventing new scars. Maintaining a healthy weight can reduce friction in skin folds where HS commonly occurs, and quitting smoking can improve wound healing and decrease flare-ups. Avoiding tight clothing helps reduce irritation, while proper wound care for active lesions promotes healthier healing. Dietary adjustments, such as avoiding certain trigger foods and incorporating anti-inflammatory options, along with stress management, can also contribute to overall skin health and reduce HS flares. Laser hair removal can reduce hair follicles, implicated in HS development, potentially minimizing future flare-ups.