How Can You Reduce Hidradenitis Suppurativa (HS) Scars?

Hidradenitis suppurativa (HS) is a relentless, inflammatory skin condition that manifests as painful nodules beneath the skin, primarily in high-friction areas such as the armpits, groin, buttocks, and beneath the breasts. These lesions often begin subtly—mere pimple-like protrusions that, over time, morph into swollen, inflamed, and excruciatingly tender abscesses. Before they rupture, they may appear deep red, purple, or even darker than your natural skin tone. Healing is frustratingly slow, and recurrence is common, leaving behind an ever-growing tapestry of scars.

This chronic cycle of inflammation and healing results in an array of scarring, ranging from minor discoloration to hypertrophic, raised tissue (keloids) or atrophic, sunken indentations. Beyond the physical discomfort—restricted movement, and persistent irritation—these scars can take a significant toll on self-confidence and body image. Fortunately, dermatological interventions exist to mitigate these lasting marks, with surgical procedures often providing the most effective results.

Surgical Interventions for HS Scars

Excision

Excision is a surgical technique that removes deeply embedded scar tissue, particularly when the scarring is painful or impairs mobility. In cases where extensive tissue removal is necessary, surgeons may employ skin grafting, a procedure in which healthy skin from another part of the body is transplanted over the excised area. Alternatively, they may use a skin flap, which involves shifting adjacent tissue to reconstruct the affected site, fostering a more natural healing process.

Deroofing

Deroofing is a lesser-known but highly effective method for addressing HS scars. This procedure entails the meticulous removal of the upper layer of affected tissue, exposing the tunnels (sinus tracts) formed by HS lesions beneath the skin. By allowing the area to heal from the inside out, deroofing reduces the likelihood of continued inflammation, infection, or recurrent abscess formation. This technique is particularly advantageous for interconnected tracts that cause chronic discomfort and limit mobility.

Laser Therapy: A Precision Approach

Laser Resurfacing

Laser resurfacing employs concentrated beams of high-energy light to refine scarred tissue. This approach removes damaged skin layer by layer, alleviating pain, reducing itching, and, in cases where scars impair movement, improving flexibility. While laser therapy does not completely erase scars, it stimulates collagen production, promoting the regeneration of smoother, more uniform skin.

Post-procedure, mild swelling, itching, and a stinging sensation may persist for a few days. Over the following week, the outermost layer of treated skin gradually peels away, unveiling healthier skin beneath. Depending on the scar’s depth and location, full recovery can range from 10 to 21 days. Often, multiple sessions are required to achieve optimal results.

Retinoids: A Controversial Contender

Retinoids, derivatives of vitamin A, are widely recognized for their role in treating acne, but their efficacy in addressing HS scars remains a subject of ongoing debate. Certain topical retinoids, such as Differin (adapalene) and Avage (tazarotene), exhibit anti-inflammatory properties and can enhance skin cell turnover. Some experts suggest that these formulations may assist in fading post-inflammatory discoloration and refining the texture of atrophic HS scars.

However, the lack of comprehensive studies on retinoids for HS scarring means their potential benefits remain largely anecdotal. If prescribed, results may take months to manifest, requiring consistent application to yield any noticeable improvements.

Scar Treatments with Limited Effectiveness for HS

Some widely recognized scar treatments may be ineffective for HS-related scarring due to the nature of these lesions. While more research is necessary, the following approaches may yield minimal results:

Scar Creams and Lighteners

Topical scar creams containing hydroquinone, salicylic acid, or retinoids are often marketed as solutions for hyperpigmentation and superficial scars. However, their impact on HS scars is largely speculative. If effective, results take months, and they are most beneficial for newly formed discoloration rather than deep, fibrotic scars.

Dermabrasion & Microdermabrasion

Dermabrasion involves mechanically exfoliating the skin’s upper layers to refine its texture, while microdermabrasion offers a gentler, non-invasive alternative. Though these techniques are beneficial for acne scars, their effect on HS-induced scarring remains uncertain, as they do not target the deeper layers of damaged tissue.

Microneedling

Microneedling, or collagen induction therapy, utilizes fine needles to create micro-injuries in the skin, stimulating collagen production and promoting skin regeneration. While effective for atrophic scars, the risk of irritation and potential flare-ups in HS-prone skin makes this treatment less desirable for some patients. The procedure requires multiple sessions, with visible improvements emerging gradually over time.

Scar Massage

Regular scar massage, particularly for hypertrophic or keloid scars, may enhance flexibility and alleviate tightness. When performed consistently for at least six months, this method can improve scar mobility and reduce discomfort. Using moisturizing agents such as shea butter, cocoa butter, or silicone-based creams can enhance the massage’s effectiveness.

Can You Prevent HS Scarring?

Preventing scars from HS flare-ups is challenging, but proactive care can minimize their severity. Implementing the following self-care strategies may reduce the frequency and intensity of breakouts, ultimately lowering the risk of scarring:

• Use antimicrobial cleansers: Wash affected areas with products containing benzoyl peroxide or zinc pyrithione to help manage bacterial overgrowth.
• Avoid aggressive scrubbing: Gentle cleansing prevents unnecessary irritation without exacerbating inflammation.
• Practice cautious hair removal: Shaving and waxing can provoke irritation and cause lesions. If hair removal is necessary, consider laser hair reduction, which may reduce the frequency of HS flare-ups.
• Refrain from picking at lesions: Squeezing or manipulating HS bumps increases inflammation, heightening the risk of infection and scarring.
• Opt for breathable clothing: Loose-fitting garments made from soft, non-irritating fabrics reduce friction and irritation.
• Choose skin-friendly deodorants: Select alcohol-free, fragrance-free formulas to prevent irritation.
• Consult a dermatologist regularly: A specialized treatment plan, including antibiotics, biologics, or anti-inflammatory medications, can help control HS and minimize scarring over time.

Final Thoughts

Hidradenitis suppurativa scars can be physically and emotionally distressing, but various treatments exist to improve their appearance. Surgical options like excision, deroofing, and laser resurfacing provide significant results, while topical retinoids and certain scar therapies may offer moderate improvement. Some commonly recommended treatments, like dermabrasion and microneedling, may not be suitable for HS-specific scars.

The key to reducing HS scarring lies in early intervention, diligent self-care, and collaboration with a dermatologist to tailor a treatment plan that addresses both active flare-ups and residual scarring. By taking a proactive approach, you can better manage the condition and minimize its long-term effects on your skin and overall well-being.