Scarring is a very common problem in people with hidradenitis suppurativa (HS). Scarring due to HS can cause pain and restrict movement, especially in the armpits and groin. Even when HS is well controlled or in remission, the scars remain. Although the physical effects of scars can be significant, many people with HS find that scars have a profound impact on their self-image and social activity, including romantic relationships and physical intimacy.
More than 1,000 members of myHSteam report scarring as a symptom of their HS. One member wrote, “It’s extremely painful, and my body is so full of scarring.” Many members share their frustration regarding how scars make them feel about their bodies. “I feel gross and unattractive,” one member wrote. According to another member, “The pain is way easier to deal with than the scarring.” Another member added, “I hate looking at myself in the mirror, wishing my skin didn’t show scars of HS. It makes me feel like I’m ugly.”
Members also share how scars have affected their interpersonal relationships. According to a myHSteam member, “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.” Another wrote, “The scars are definitely keeping me from meeting anyone on an intimate level.” One member explained how HS affects her marriage, “Really tough on my relationship with my husband. I am embarrassed at all the scars I have. I wish I didn’t have to leave the house.”
Scars are permanent, but treatments may be able to reduce their size and make them less noticeable. Many over-the-counter treatments are effective at treating smaller scars, but these may not be as useful for extensive scarring due to severe HS. Medical treatments available to reduce visible scarring are usually provided by a dermatologist or cosmetic (plastic) surgeon. Scar treatments include:
Steroid injections to reduce the size of scars are one of the most common treatments in dermatology. Steroids are injected directly into the scar, reducing inflammation and slowing the collagen production that produces scar tissue. Several side effects are associated with injections, including pain, bleeding, and rarely, a form of eczema. Small white marks may form on the skin after several treatments.
Injections of fluorouracil or bleomycin (usually used as chemotherapy drugs) can be injected into raised scar tissue, including thick, raised scars called keloid scars. These injections can reduce the size of raised scars as well as improve pain, itching, hardness, and discoloration. Fluorouracil and bleomycin may be combined with steroid injections or laser therapy.
Pressure dressings placed on scars and wounds can prevent the development and spread of scar tissue, including keloid scars. Pressure dressings can be a tight-fitting bandage, stocking, or sleeve. They may need to be worn as long as a year and may need to be replaced every six to eight weeks.
Medical-grade silicone ointment, silicone gel sheets, bandages, or sprays are effective for treating raised scars. Topical silicone comes in several different forms, making it appropriate for any part of the body. Both over-the-counter and prescription options are available. Silicone allergy, while very rare, can occur with topical silicone. If you have had an allergic reaction to silicone before, do not use this treatment.
For scars that do not deeply penetrate the skin, dermabrasion is most commonly used. 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. Side effects can include acne breakouts in the treated area, infection, and swelling. Dermabrasion may not be a desirable option for people with darker skin tones because darker skin is often discolored by this treatment.
A chemical peel uses chemicals applied to the skin to remove the top layers of scarred skin. Light chemical peels only remove the superficial skin (epidermis). Medium and deep chemical peels can extend into the dermis, the deep layer of skin. Side effects of chemical peels include redness, swelling, pain, and blisters that can last for weeks after the procedure. Certain medications may need to be stopped before undergoing a chemical peel. Light and medium peels may need to be repeated to see the desired results.
Scarring due to HS may require surgery to reduce or remove scars. Surgery to remove scars may also improve pain, itching, discoloration, and movement. Some surgical procedures, such as scar revision and skin grafts, create new or additional scars — but these can be treated to minimize scar formation. Surgical procedures to treat HS scars include:
Different types of laser therapy can be used to reduce the size and visibility of scars, reduce pain and itching, and improve the movement of tight or hardened scar tissue. Lasers can:
A potential side effect of laser treatment is hyperpigmentation (darkening) or hypopigmentation (lightening) of skin in the treated areas.
Cryosurgery freezes the scar and the surrounding area. It works similar to laser therapy but uses cold instead of light and heat. In addition to reducing the size of the scar, cryosurgery also improves itching, pain, and discoloration. The procedure has a low risk of side effects.
Surgical scar revision involves excising (cutting out) scar tissue and rejoining the skin. This can create a new scar that can be less visible, especially when combined with other scar-reducing therapies. Scar revision can reduce the size of scar tissue and improve the range of motion in scars that have formed contractures.
Skin grafts involve taking healthy skin from one area of the body and using it to cover areas where skin and scars have been surgically removed. The two main types of skin grafts are split skin grafts (partial-thickness skin grafts) and full-thickness skin grafts. Split skin grafts are “shaved” off of the thighs, buttocks, or back. Full-thickness grafts require removing whole pieces of skin. For small scars that are depressed or form pits, punch grafting is an effective technique. The scar is removed with a skin punch and replaced with a punch of skin removed from somewhere not noticeable, such as behind the earlobe.
For severe HS that has formed large areas of active lesions and scarring, surgery to remove the affected tissue may improve HS symptoms and scarring. For example, surgery can be used to remove the entire armpit, including HS lesions, scars, and all skin with hair follicles in the area. Although this will lead to new scarring at the surgical site, the development of new scars can be controlled using the various treatments described above. The affected area can be cosmetically improved using procedures such as skin flaps and skin grafts.
Some myHSteam members are hoping to prevent new HS scars. “Could anyone share what remedies they tend to use when you can tell the abscess is going to scar badly?” asked one member. Another asked, “I am having a flare-up, and I can tell it’s going to leave pretty bad scars. Does anyone have any tips for something I could do/use to prevent bad scarring or help it after?” There is no foolproof way to prevent scars from forming, but there are methods to reduce scarring:
Several members have found over-the-counter treatments helpful, including Mederma, ScarDerma, and ScarAway. One member recommended Emuaid: “I ordered a small jar once, and it did seem to help with pain and scarring!”
At least one member had plastic surgery for their scars, “I had a plastic surgeon remove the scars, and our medical aid paid for the procedure.” Another member wrote, “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.”
A positive attitude has helped some myHSteam members cope with their scars. One member wrote, “I came to a point in my life where I don’t care what other people think when they look at me.” Another member wears their scars as a badge of honor and commented, “The scars are TRULY a challenge … BUT, they also are beauty marks reflecting how you continue on as a warrior in this fight no matter how hard it is. Remember that!”
On myHSteam, the social network for people with hidradenitis suppurativa/acne inversa, more than 23,700 members come together to ask questions, give advice, and share their stories with others who understand life with HS.
Are you or is someone you care for living with HS? Share your experience in the comments below, or start a conversation by posting on your Activities page.