How To Treat Hidradenitis Suppurativa Scars

Hidradenitis suppurativa (HS) is a chronic inflammatory condition that causes cysts to form on and under your skin. If HS is left untreated, broken cysts can leave deep scars behind and permanently affect the appearance of your skin. For many, these scars can be painful and itchy. But they can also be a source of emotional stress and low self-confidence.

Dermatologist Michelle Kerns, MD, shares several ways to prevent the severity of scar tissue and why it’s important to treat hidradenitis early.

Treatment options for HS scars

With HS, there isn’t a known cure. Although the condition can remain dormant or inactive for some time, like psoriasis, flare-ups do occur. And when they do, it’s important to address them as early as possible before HS progressively gets worse.

“When cysts form, they connect with each other under the skin through deep tunnels that pull your skin down,” explains Dr. Kerns. “It almost causes a tent-like phenomenon, where your skin will create ridges and then you’re left with these deep scars on your skin.”

Fortunately, there are a few things you can do to reduce scarring when flare-ups happen.

At a minimum, you should avoid picking or popping HS cysts. Pay close attention to your symptoms and seek medical care at the earliest stages of flare-ups to avoid an increase in cysts and scar tissue.

Otherwise, there are at-home solutions you can use, along with helpful treatments that reduce the severity and likelihood of scar tissue.

Steroid injections

Steroid injections can be used to reduce inflammation in an inflamed cyst. This is especially beneficial if you’ve had a cyst break open because the inflammation doesn’t go away even when it’s been drained. By reducing inflammation, you reduce the potential for further cyst formation and decrease the pressure build-up that causes deep scars.

Biologic injections

Biologics are medications made from organic life. In the realm of HS, the U.S. Food and Drug Administration (FDA) has begun approving the use of biologics to directly target specific inflammatory responses that cause HS cysts to form. These new injections include secukinumab (Cosentyx®) and adalimumab (Humira®), and there are more on the horizon.

Laser surgery and excision

For severe hidradenitis suppurativa, there are surgical options. Removing individual cysts, as well as the deep tunnels that connect them, allows your skin to fall flatter, reducing the severity of any eventual scar tissue. This is also helpful because those deep scars can sometimes cause problems with movement, including a feeling of tightness or pressure.

If you have larger areas of scar tissue involving surface scars or deep, inflamed follicles, you may want to consider laser surgery instead of excision. Not only can it cover a wider affected area, but it can also stimulate the growth of new skin so it’s smoother over time.

Scar tissue massage

By pulling and stretching scar tissue, massage therapy can help soften and flatten scars so they become less noticeable. As HS often tights skin, massage therapy may return some much-needed flexibility to your skin surface, reducing the severity of future scars.

Topical creams and ointments

Talk with your healthcare provider about the best soaps, topical creams and other ointments you can use that can help reduce scar tissue. The trick is to make sure you pick topical treatments that won’t trigger your HS flare-ups. In general, anything you use should be free of fragrances, dyes, parabens and exfoliators.

Dermabrasion and microneedling

These two treatments are helpful when treating acne scars, and they could work for HS, too. Dermabrasion involves using a small tool to remove the top surface layer of the skin in an effort to smooth out scars.

Microdermabrasion does the same thing but is more minimally invasive, with shorter appointments spread out across longer periods. And microneedling involves the use of thin needles to puncture scar tissue and stimulate new skin growth.

Preventing and reducing the severity of HS scars

Scarring may be inevitable if you have HS. But, again, you can reduce the severity of the scars that form by treating flare-ups as early as possible.

“If you have a hole in a bucket that’s full of water, and you don’t patch that hole. The water will keep dripping and you will never have a bucket full of water,” illustrates Dr. Kerns. “We need to start treating the hidradenitis, and once the hidradenitis improves, some of the scarring or future scarring will improve to a certain degree.”

Get an early diagnosis

At the first sign of pimples or cysts on parts of your body where you grow hair (like your armpits, groin and buttocks), you should see a healthcare provider. Although these may appear like normal acne, if they’re consistently popping up and usual acne treatments aren’t working, you should have them looked at. Left untreated, your cysts connect with each other and, if they continue to be inflamed, they can grow, develop pus and eventually break open. This is what causes scar tissue to form.

Keep your wounds clean and moisturized

If you have a broken cyst that produces discharge, blood or pus, make sure you keep the area clean and disinfected. You can use rubbing alcohol to clean the surface, but try not to do this often because it can dry out your skin and cause further scarring.

Aloe vera and other moisturizing creams and topical ointments are available to help keep your skin from drying out. But the most important thing is to keep the surface of your skin clean. This will limit further infection until you can see your doctor for further treatment.

“Anything that’s oozing or having a discharge should be bandaged,” advises Dr. Kerns. “You don’t want that discharge to touch other parts of the body because it can spread.”

Laser hair removal

Laser hair removal reduces the number of hairs in one area across several treatments. By removing hair, you prevent infection and the initial clogging of pores that leads to inflammation and hidradenitis suppurativa flare-ups.

“If we get rid of the hair, 30% of the problem is solved because that hair is not coming out and causing inflammation,” explains Dr. Kerns. “I recommend all patients who have hidradenitis suppurativa get laser hair removal early on after receiving a diagnosis.”