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Scarring from hidradenitis suppurativa (HS) can be more than just skin deep. Scar tissue caused by boils or tracts connecting affected areas under the skin can be painful and limit movement, especially when found on the thighs or armpits.
“I have many such scars,” a member of myHSteam said. More than 700 myHSteam members report scarring as a symptom of their HS, and many have shared their frustration. “Another scar to add to so many. … Fed up with it.”
One member said, “I feel gross and unattractive.” Another was especially blunt, “I've had this condition for over 30 years and will not get involved in a relationship because of all my scars and ongoing flare-ups.”
There are treatments available that can reduce the size and appearance of scars (although they never fully go away). When scarring is excessive, as it is with many people with severe hidradenitis suppurativa, over-the-counter scar treatments are usually not much use.
That doesn’t mean nothing can be done, however. Your dermatologist may have a variety of different options to treat scarring. These methods include:
Steroid injections to reduce the size of scars are one of the most common treatments for scars in dermatology. Steroids are injected directly into the scar, where they diminish inflammation and slow collagen production to the skin that makes more scar tissue. There are several side effects that have been associated with injections, including pain, bleeding, and rarely, a form of eczema. Small white marks may form on the skin after several treatments.
Pressure dressings can reduce the spread of scar tissue, prevent it from developing, and keep scarring from coming back after it has been surgically removed. Pressure dressings are usually a tight-fitting bandage, stocking, or even an earring. They may need to be worn as long as a year, and must be replaced every six to eight weeks.
Silicone gel treatment is a self-drying gel applied to scarred areas. Since it’s a gel, it can easily be spread on joints and other movable areas. It protects scars from bacterial infection, allows skin to breathe normally, and reduces itching and swelling associated with scars. It must fully dry before it can be used under clothing. A very small amount of people are allergic to silicone, so after applying such a treatment you should watch the area. If you have had an allergic reaction to silicone before, do not use this treatment.
Dermabrasion is most commonly used for scars that do not deeply penetrate the skin. The skin is numbed with a local anesthetic or freezing agent and is then scraped with a wire brush tool or a diamond wheel to remove the scarred layers. It’s best used on light skin; darker skin is often discolored by such treatment. Side effects can include acne breakouts in the treated area, infection, and swelling.
A chemical is applied to scarred skin that peels off the most superficial layers. There are three kinds of peels: light peels that only remove a few layers, medium peels that remove the outer layers of skin and penetrate the middle layers (dermis), and deep peels that penetrate most of the dermis. Deep peels can only be done once, but light and medium peels can be used multiple times. Certain medications may prevent you from getting a chemical peel; ask your dermatologist if anything you take may prevent the procedure from being done.
Surgery is available for the most severe cases of scarring. Several types of surgical procedures can be used:
Skin grafting is sometimes referred to as punch grafting. Skin is removed from the back of the ear and a hole is punched in the skin near the scar. The skin from the ear is then grafted onto the hole. “I had skin grafts under both arms,” one member said.
Laser removal has become one of the more popular surgical treatments for scars. The process can reduce pain and itching from a scar, increase range of motion limited by a scar, prevent scars from forming after surgery, and make them thinner and less noticeable. Before getting laser removal, you will need to see a dermatologist. They will want to know if you have any other skin conditions, like cold sores, and what medications you take. Laser treatment cannot be performed on sunburned or tanned skin. After surgery, you will need to follow specific instructions in wound care for the healing area.
Cryosurgery treatment freezes the scar and the surrounding area. It reduces the size of the scar as well as reducing itching, pain, and discoloration. This is another popular surgery option for scars because the risk of side effects is low.
A scar revision procedure involves a dermatologist removing skin that is scarred and rejoins the skin. This usually creates a scar as well, but the goal is to make a less obvious or restrictive one. At least one member found this to be the best solution. “The only thing I've found to help is removing all the scarred, tunneled, and diseased tissue.”
There’s no foolproof way to prevent scars from forming, but there are methods to reduce scarring.
Plastic surgery was needed for at least one member. “I had a plastic surgeon that removed [the scars] and our medical aid paid [for the procedure].” Another member said, “I've never been offered any surgery and have been told nothing can be done for the scars.” The same member went on to say, “I have found Sudocrem does help to dry them up though.”
One member did find an over-the-counter treatment helpful. “ScarDerma; it's an ointment.” Another recommended Emuaid. “I ordered a small jar once and it did seem to help with pain and scarring!”
At least one member found mental attitude was as important as physical treatments. “I came to a point in my life where I don't care what other people think when they look at me.”
Another strongly spoke out against lancing boils. “My advice — never let [doctors] lance them. Doctors are becoming more educated and they now know that it may bring instant relief, [but] it causes them to dig deeper and cause more scarring.”
Here are some recent myHSteam conversations about scarring:
Are you dealing with scarring? Do you have a way to treat it? Comment below or start a conversation on myHSteam.
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