How to Prevent Hidradenitis Suppurativa Scars

The chronic inflammatory skin disease hidradenitis suppurativa (HS) can create scars. While the exact cause of HS is unknown, hormones, genetics, and environmental factors play key roles in developing the disease.

HS causes sudden eruptions of abscesses (boils) and nodules on the skin near hair follicles. These are intensely sore and result in abnormal pigmentation and scars. The abscesses most commonly occur around skin folds in the armpits, groin, abdomen, and breast areas. This can make movement and basic activities very difficult.

While there is no cure for HS, there are treatments to slow progression and help minimize flare-ups (times when symptoms worsen). During a flare-up, multiple abscesses may form. These can erupt and cause pain. Scarring and sinus tracts (small tunnels under the skin) can occur as the abscesses heal.

In this article, you will learn ways to prevent, minimize, and help heal your hidradenitis suppurativa scars.

Treating Hidradenitis Suppurativa Scars

HS scars can be treated to minimize their appearance. A healthcare provider can help you determine which treatment is best for your unique situation and type of scar.

There are six types of HS scars:

• Hyperpigmented: These scars are darker in color than your unaffected skin.
• Hypopigmented: These scars are lighter in color than the unaffected skin.
• Atrophic: These are shallow scars with a slight indentation, such as occurs with severe acne.
• Hypertrophic: This is a thick, raised, or ropelike scar.
• Erythematous: These are small, flat, red marks on the skin.
• Made of tracts: As HS progresses, sinus tracts can form under the skin connecting several abscesses. When these heal, the tracts can scar into one large tract.

Each type of scar requires a different type of treatment.

Dermabrasion or Microdermabrasion

Dermabrasion and microdermabrasion (a gentler form of dermabrasion) are minimally invasive procedures that do not require recovery time. They minimize the appearance of scars by using surgical instruments to remove the top layers of the affected skin to encourage new growth.  

While dermabrasion and microdermabrasionare effective at producing significant improvements in skin appearance, it often takes several treatments over a period of time to see results. Though the treatments work well on superficial scars they are less effective on deep scars.

Microneedling

Microneedling uses a barrel of tiny needles that is rolled over the skin to cause thousands of micropunctures. These tiny punctures initiate a healing process that produces collagen (a protein in the skin). Collagen helps replace the skin of the scar and lessen its appearance.

There are several advantages to this treatment. It is cheaper, requires less recovery time (two to three days), allows for treated and untreated skin to blend together, and is less likely to cause changes in pigmentation. Results can usually be seen at about six weeks but could take three months.

Laser Resurfacing

Though studies on laser resurfacing for HS scars are limited, there is promise. Laser resurfacing has been used on traumatic scars from other causes (such as cuts) quite effectively.

The treatment works by using targeted light or laser devices that hit the affected skin creating improvements in color and texture. Laser resurfacing can also help with movement if the scar tissue is affecting mobility.

Treatment can be done without anesthesia and downtime is minimal. However, those with darker skin may need to be treated with more caution as the risk of abnormal pigmentation is higher.

Surgical Removal of HS Scars

Some HS scars, especially those that occur in later stages of the disease, may cover large areas or include sinus tracts under the skin. This can cause disfiguring scarring that may require surgery.

For best results, surgery should be done when your HS is in its least inflammatory state. Having surgery during a flare-up may put you at risk for less optimal results and more scarring.

Surgery for HS scars can include:

• Skin grafting: Healthy skin from a donor or another area of the body is transplanted to an area of scarring that’s been removed.
• Laser removal: This helps restore fresh skin tissue.
• Cryosurgery: Parts of the scar are frozen to encourage new skin growth.
• Scar revision: Scars can be cut and removed to form a smaller, less restricting scar.

Scar Creams and Lighteners

In the early stages of HS, scar creams and lighteners can help reduce the appearance of superficial scars. These creams work by lightening the color of the scar or by helping the tissue heal so as to prevent scars.

Topical creams that can be used for HS scars include:

• Mederma
• Bio-Oil
• Scaraway
• CELSUS
• Aloe
• Lemon
• Cocoa butter

If you are considering a topical cream, talk to your healthcare provider as some creams such as Bio-Oil and Mederma should not be used on open wounds.

Scar Shrinking Injections

HS scars can also be treated with injections of cortisone or collagen. Collagen is injected beneath the skin of the scar to promote new skin growth. Cortisone injections can soften and shrink scars by lowering the inflammation under the skin.  

Birth Control Pills

While more research needs to be done into the link between hormones and HS flares, one study found that the use of birth control pills in females with HS helped them manage flares that would worsen throughout their menstrual cycle.

Preventing Hidradenitis Suppurativa Scars

Preventing scarring from HS starts with minimizing and preventing flare-ups, which cause the abscesses that create scarring. This can be done through lifestyle modifications and at-home treatments of the abscesses that occur with HS.

Hidradenitis suppurativa scars occur as the erupted abscesses of HS heal over time. In the early stages of HS, scarring may be superficial, affecting only on the top layers of skin. As the disease progresses, sinus tracts may form. There may also be more abscesses and scarring can become substantial.

Laser Hair Removal

Flare-ups of HS are often caused by irritation. Shaving is a known irritant. Laser hair removal is often better than shaving to minimize inflammation.

Stop Smoking

Smoking is a known trigger for HS. Ceasing smoking can help prevent flare-ups and the scarring that may follow.

Weight Loss as Needed

Obesity is associated with increased incidences of HS. Being overweight not only makes you prone to flare-ups but it also causes skin irritation in areas of more folds.

Scar Massage

Massaging a scar can help even out the skin, prevent scars from causing mobility problems, improve blood flow to promote healing, and decrease further scar tissue buildup.

To massage a scar, make sure that any scabbing has healed. Use an oil like vitamin E oil to apply smooth pressure along the scar tissue.

Scar Dressings

Properly caring for the wounds that occur when the abscesses burst can help minimize scarring. This includes cleaning the wound to avoid infection.

As the wound heals, a scar dressing can help minimize the appearance of the scar. In postoperative studies, people who kept the wound covered and moist with petroleum jelly for three weeks saw an improved scar. Anecdotally, vitamin E, Mederma, and cocoa butter also appear to help with scarring.

Cleansers

Cleansers that minimize flare-ups and promote healing of HS lesions can also help prevent scars. Medicated cleansers and other products with benzoyl peroxide, salicylic acid, or chlorhexidine digluconate can be used on skin affected by HS. However, it is important to talk to your healthcare provider to find what is best for you.

Sunscreen

Scar tissue is sensitive to the sun making it more susceptible to sun damage and abnormal pigmentation. Covering the scar with sunscreen can help. However, it is best to choose non-irritating sunscreens as chemical-laden products can irritate HS.

Moisturize

Certain products like Mederma contain dimethicone, a silicone-based polymer, which protects the skin and improves scar texture. Moisturizing with these topical moisturizers can help prevent scarring.

Over-the-Counter Cortisone Creams

Cortisone creams can decrease inflammation and minimize the appearance of scars. Be sure to talk to your healthcare provider if using these creams as overuse can cause thinning of the skin.

Coping With HS Scars

Living with a condition that has no cure can be difficult, producing many different emotions. It is well known that having physical pain from HS scars or losing some of your mobility can affect your quality of life. Feeling self-conscious about HS scars is also a normal reaction.

Talk to your healthcare provider or qualified mental health professional if your HS scars are causing you to feel depressed or they are affecting your everyday activities. There are options to help.

Summary

While hidradenitis suppurativa scars are a typical complication of living with the condition, there are ways to minimize their appearance and the amount of scarring.

Treatment options include preventing flare-ups through methods like weight loss and quitting smoking, treating the scars with laser therapy or microneedling, and taking care of your skin with medicated cleansers and moisturizers.

A Word From Verywell

Taking a proactive approach to your care when living with HS can help give you a sense of control. Learning about your treatment options and discussing them with your healthcare provider can help you discover the best ways to cope with the disease.

Address your concerns with your healthcare provider. Connecting with others who live with the condition can also help you feel less alone.