Hidradenitis suppurativa is a painful and persistent chronic condition that causes cysts to form on and under your skin. If left untreated, broken cysts can leave deep scars behind and permanently affect the appearance of your skin. For many, these scars can be painful, itchy, and a source of emotional stress and lack of self-confidence.
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Dermatologist Asfa Akhtar, DO, explains a number of ways to prevent the severity of scar tissue and why it’s important to treat hidradenitis early.
Hidradenitis suppurativa is a chronic condition, so there isn’t a known permanent cure. Like psoriasis, flare-ups can happen on occasion. When they do, it’s important to address them as early as possible before your condition worsens.
“When cysts form, they connect with each other under the skin through deep tunnels that pull your skin down,” explains Dr. Akhtar. “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.
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 your doctor. Although these may appear like normal acne, if they’re consistently popping up and normal 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.
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 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. And you should never pop them.
“Anything that’s oozing or having a discharge should be bandaged,” advises Dr. Akhtar. “You don’t want that discharge to touch other parts of the body because it can spread.”
At a minimum, you should pay close attention to signs and symptoms and seek medical care at the earliest stages to avoid an increase in cysts and scar tissue. But there are other solutions you can use, too, with the help of a board-certified dermatologist.
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,” says Dr. Akhtar. “I recommend all patients who have hidradenitis suppurativa get laser hair removal.”
Steroid injections can be used to reduce inflammation in an inflamed cyst. This is especially helpful if you’ve had a cyst break open because the inflammation doesn’t go away even when a cyst has been drained. By reducing inflammation, you reduce the potential for further cyst formation. You also decrease the pressure build-up that causes deep scars to form.
For severe hidradenitis suppurativa, there are surgical options. Removing the cysts, as well as the deep tunnels that connect them, allows your skin to fall flatter, reducing the severity of the scar tissue. This is helpful because those deep scars can sometimes cause problems with movement, including a feeling of tightness or pressure. You can also benefit from laser surgery to remove large areas of scar tissue that includes surface scars and deep, inflamed follicles.
If you have hidradenitis suppurativa, scarring is inevitable. But you can reduce the severity of the scars that form by treating flare-ups as they happen early on.
“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,” says Dr. Akhtar. “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.”