Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic inflammatory skin condition that causes painful, recurring lumps to form under the skin. These lesions often develop into skin sores that can break open and drain, eventually leading to various types of scarring. The resulting scars can cause significant physical discomfort, including restricted movement in affected areas, and may lead to considerable emotional distress. This article will explore the methods available for managing and reducing the appearance of hidradenitis suppurativa scars.
Understanding Hidradenitis Suppurativa Scars
Hidradenitis suppurativa lesions heal in ways that can lead to several distinct scar formations. Hypertrophic scars, for instance, are thick and raised due to an overproduction of collagen during the healing process. These scars remain within the boundaries of the original wound and may appear red or pink. Keloid scars, while less common in HS, represent an overgrowth of tissue that extends beyond the original wound margins and can be raised, itchy, or darker in pigmentation.
Atrophic scars appear as depressed or indented areas in the skin, resulting from a loss of tissue when the skin cannot fully regenerate after inflammation. A unique and severe characteristic of HS is the formation of tunneling scars, also known as sinus tracts. These are narrow, interconnected channels that develop under the skin, often filled with pus or blood, and can continuously drain. Such tunneling can destroy more skin tissue and lead to thickened, rope-like scars, significantly impacting mobility.
Non-Surgical Treatment Approaches
Non-surgical methods offer various ways to reduce the appearance and symptoms associated with hidradenitis suppurativa scars, typically performed in a clinical setting. Topical treatments can be part of a scar management plan. Silicone sheets and gels, for example, are applied to scars and work by creating an occlusive barrier that hydrates the tissue and helps regulate collagen production. This action can lead to softening and flattening of raised scars.
Injectable treatments deliver therapeutic agents directly into the scar tissue. Intralesional corticosteroids, such as triamcinolone, are frequently used to reduce inflammation and flatten hypertrophic scars. These injections can quickly alleviate pain and swelling, contributing to improved scar appearance. Another injectable, 5-fluorouracil (5-FU), is an anti-metabolite that promotes scar degradation. This agent is often combined with corticosteroids to enhance efficacy and reduce potential side effects.
Light-based therapies utilize specific wavelengths to target and remodel scar tissue. Pulsed Dye Lasers (PDL) are effective for red or inflamed scars, as they target blood vessels within the scar to reduce redness, soften its texture, and flatten scars. Fractional ablative lasers, such as CO2 lasers, create microscopic columns of controlled injury in the skin. This process stimulates intense collagen remodeling and resurfacing, which helps to improve the height and texture of deep or hypertrophic scars. These lasers can also target and destroy sinus tracts.
Non-ablative fractional lasers, a gentler alternative, stimulate collagen production and promote skin remodeling without removing the top layer of skin, leading to less downtime. Microneedling is another procedure where tiny needles create microscopic punctures in the skin. This controlled injury stimulates the body’s natural healing response and collagen production, which can improve the texture and appearance of various scar types, including atrophic scars. These light-based and mechanical treatments generally aim to improve scar texture, reduce discoloration, and promote the growth of healthier skin cells.