Hidradenitis suppurativa (HS) causes painful bumps under the skin, usually in skin folds, such as the groin area, armpits, inner thighs, buttocks and under the breasts. Bumps often start as small, pimple-like spots that grow slowly. They may appear swollen, red, or darker than your normal skin color, and may be itchy, tender, or extremely painful before the bumps break or burst. Healing is slow, and bumps may recur.
This cycle of inflammation and healing can cause significant scarring. HS scars range from small, discolored spots to raised, thickened scars (keloids) or dimpled, dimpled skin. Many people seek treatment because scars are often painful, restrict movement, and affect body image.
Treatment by a dermatologist (a doctor who specializes in skin conditions) can help improve the appearance of the skin and reduce discomfort. Surgery is currently the most common approach. Procedures such as excision and deroofing can remove or repair scar tissue to reduce the appearance of a scar when other treatments are ineffective.
Excision is the surgical removal of scar tissue. It is an option for deep, painful scars and scars that limit movement.
Surgeons sometimes use skin grafts to cover the scarred area. This involves transferring healthy skin from another part of the body and grafting (placing) it over the removed scar. In other cases, healthcare professionals may use a flap, which involves moving nearby tissue to repair an area of scarred skin.
Deroofing involves removing the top layer of affected HS lesions (bumps), allowing the area to heal from the inside out.
During the procedure, the doctor removes the “roof”, or top layer of skin, that covers the tunnels (sinus tracts) formed by HS protrusions deep below the skin’s surface. Unroofing exposes the underlying tissue, allowing the area to heal more evenly and reducing the likelihood of further inflammation or infection.
Deroofing is especially effective for chronic, interconnected scars and tunnels. It relieves pain and improves mobility in the affected area.
Laser resurfacing uses high-energy light to treat HS scars by removing thin layers of damaged skin (scars) to relieve pain and itching and improve mobility if scarring limits movement.
Although laser treatment can make a sunken or raised scar less visible, it does not remove it completely. However, the treatment stimulates collagen production and the growth of smoother, more even skin. The heat of the laser penetrates the deeper layers of the skin and stimulates the production of collagen, which leads to smoother skin.
After the laser treatment, you may experience swelling and slight itching or burning for up to three days. Over the next 5-7 days, the outer layer of skin will peel off as part of the healing process. Depending on the size and location of the scar, recovery time ranges from 10-21 days.
Depending on the severity of the scars, you may need several sessions of laser therapy for optimal results.
Retinoids are chemical compounds made from vitamin A. They can be applied to the skin (topically) to treat several skin conditions, including acne. Retinoids have not been extensively studied for the treatment of HS, although some believe they may be helpful.
Some experts believe that the topical retinoids Differin (adapalen) or Avage (tazarotene) may benefit HS scars because of their anti-inflammatory effects and ability to break down the first layer of skin. The products have been shown to improve post-inflammatory skin discoloration and sunken (atrophic) acne scars, which may prove beneficial in reducing the appearance of HS scars.
Other scar reduction techniques are available, but they may not work well on HS. HS leaves scars that are different from others, such as acne scars.
More research is needed to say whether the following treatments may benefit HS scars. Ask your healthcare provider if they think any of the following scar treatments might help:
Scar lightening creams and products
Scar creams and lighteners can improve the appearance of superficial (surface-level) or hyperpigmented (dark) scars. Applying these products directly to the affected skin promotes skin regeneration and healing, helping to improve skin texture and tone.
Retinoid-based products may work, but there isn’t enough evidence to say whether topical scar creams and lighteners containing ingredients like salicylic acid or hydroquinone can help reduce discoloration or stimulate skin healing in HS.
If they work, topical treatments may take several months of consistent application to see visible results. It will probably work better on new scars or areas of hyperpigmentation rather than more severe or older scars.
While topical treatments for HS scars are generally safe and well tolerated, some people may experience skin irritation or allergy-like reactions, such as itching, swelling, or redness.
Dermabrasion or microdermabrasion
Dermabrasion and microdermabrasion are exfoliation techniques that can help reduce the appearance of scars and improve skin texture.
Dermabrasion (dermaplaning) is when a dermatologist uses a special tool to surgically scrape away the top layers of the skin, giving it a smoother appearance and reducing texture irregularities, such as scars. Before scraping the skin, your dermatologist will numb the affected area.
Microdermabrasion is a gentler version of dermabrasion, where the dermatologist only removes the top layer of skin. This procedure is usually painless and recovery is minimal. You may need several sessions to notice results.
Microneedling, or collagen induction therapy, uses tiny needles to create micro-injuries (tiny punctures) in the skin. This procedure stimulates the body’s healing process, promoting the production of collagen and elastin to improve the texture and appearance of scars.
Microneedling sessions usually last about 30 minutes, depending on the size of the treatment area. You may need several sessions spaced a few weeks apart. Visible results develop gradually as the body creates new collagen. Many people notice improvements within a few weeks, but it often takes several months to see the full effects.
When performed by a trained dermatologist, microneedling is safe for all skin tones. However, some people experience a sunburn-like sensation, and the treated area may develop redness (in light skin tones) or darker spots (in darker skin tones) during healing.
Scar Massage
Scar massage is a simple and effective method for reducing the tightness, itching and discomfort of some scars. It is most effective for newer or raised, tight scars (keloids) that limit the flexibility or mobility of your skin. Scar massage can be done at home or with the help of a licensed massage therapist experienced in scar management.
Daily scar massage for at least six months can improve scar flexibility, reduce pain, and improve mobility. When the scar is no longer sensitive and has good movement, you can reduce the frequency. Apply a moisturizer such as cocoa butter, shea butter, or scar cream to reduce friction and increase your skin’s hydration.
Hidradenitis suppurativa scarring can be difficult to prevent, but identifying lesions early and following your treatment plan can reduce the likelihood and severity of scarring.
Incorporating certain self-care practices into your routine can help reduce the frequency and severity of HS flare-ups, reducing the risk of scarring. This includes:
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- Cleanse skin with an antimicrobial wash: Washes that contain ingredients like benzoyl peroxide or zinc pyrithione can help reduce bacteria on your skin, reducing the frequency of HS flares and the risk of infection.
- Be gentle with your skin: Avoid scrubbing, as it can irritate and inflame the skin, making HS symptoms worse. Gentle cleaning is enough. Remember, HS doesn’t mean your skin is dirty.
- Take care when removing hair: Shaving and waxing can irritate sensitive skin affected by HS. If you shave, first wash the area with antibacterial soap, apply a protective gel and shave carefully to avoid nicks and cuts that can lead to new lesions or infections. For a longer-lasting solution, consider laser hair removal, which can reduce breakouts by reducing hair follicles, bacteria, and sebaceous gland activity.
- Avoid picking or squeezing lesions: Manipulating affected areas can worsen inflammation and increase the risk of scarring or infection.
- Wear loose clothing: Tight or rough fabrics can irritate your skin and cause or worsen irritation and lesions.
- Choose gentle antiperspirants and deodorants: Look for products without harsh ingredients like alcohol, baking soda, parabens, dyes, and fragrances, which can cause or irritate HS lesions.
- Work with a dermatologist: Work with a dermatologist to find an effective treatment plan for HS, which may include antibiotics, biologics, or anti-inflammatory drugs, to minimize skin damage.
While hidradenitis suppurativa (HS) scars can affect your physical and emotional well-being, several treatment options can improve their appearance.
Options such as excision, deroofing, CO2 laser therapy, and retinoids can help improve the appearance of HS scars. Other treatments commonly used to treat scars may not work on HS scars.
Timely treatment of flare-ups and self-care practices can help manage flare-ups and reduce the risk of new scarring. Talk to a dermatologist to discuss which HS scar treatments may be right for you.