Strategies for Managing Scars from Hidradenitis Suppurativa
Living with Hidradenitis Suppurativa (HS), a chronic inflammatory condition, can be challenging, especially when it comes to managing the scars that often result from flare-ups. To effectively minimise scarring, a combination of medical treatments, procedural interventions, and home self-care strategies is recommended.
Medical Treatments
Topical antibiotics, such as clindamycin, can help reduce infection and inflammation in mild cases of HS, potentially minimising scarring. Oral medications, including long-term antibiotics, hormonal treatments, and short courses of oral steroids, reduce active inflammation and flare intensity, which decreases scar formation risk. Steroid injections, like triamcinolone, directly into lesions, can reduce swelling and pain during flare-ups, potentially preventing progression to scarring. Biologic therapies, such as adalimumab, target inflammation in moderate to severe cases, reducing flare frequency and tissue damage that causes scarring. In persistent or severe cases, surgical procedures like deroofing, excision, or wide skin excision are used to remove tunnels, scar tissue, and abscesses, which improves healing and can prevent new scar tissue development.
Procedural Interventions
Laser hair removal with long-pulsed Nd:YAG or alexandrite lasers destroys hair follicles, reducing follicular occlusion and inflammation—primary triggers for HS lesions and subsequent scars. This therapy is especially useful for mild to moderate HS to prevent flares and scarring. Emerging procedures like cryoinsufflation (injecting liquid nitrogen into sinus tracts), botulinum toxin injections (to reduce sweating and inflammation), and setons (loops promoting drainage) show promise in improving healing and reducing scar tissue formation but require further study.
Home and Lifestyle Care
Applying warm compresses during flare-ups can reduce pain and promote drainage, potentially reducing lesion severity and scar risk. Wearing loose, breathable clothing made of moisture-wicking fabrics can reduce skin friction and sweating that exacerbate HS lesions. Maintaining a gentle skincare routine using fragrance-free, pH-balanced cleansers, avoiding harsh soaps or scrubbing, and applying moisturiser on slightly damp skin can protect the skin barrier. Following an elimination diet to identify and avoid personal dietary triggers that may worsen HS inflammation is also recommended. Implementing stress management techniques, such as meditation, yoga, massage therapy, or counseling, can help manage chronic stress, a known trigger for HS flares and scarring severity. Quitting smoking and maintaining a healthy weight can further reduce HS severity and scarring risk.
Summary
The key to reducing scarring lies in controlling inflammation and active flare-ups early through medications and injections, preventing new lesions via laser and lifestyle modifications, and using surgical or procedural methods to remove damaged tissue when necessary. Complementary measures at home like stress management, gentle skincare, and wearing appropriate clothing support these efforts. Due to HS's chronic nature, ongoing multidisciplinary management tailored to disease severity is crucial to minimise scarring over time.
This approach integrates proven medical treatments with self-care strategies for optimal scar management in HS. If HS is left untreated, broken cysts can leave deep scars behind and permanently affect the appearance of the skin. Dr. Kerns, a leading HS expert, compares treating HS to a leaking bucket: if the hole (HS flare-ups) isn't addressed, the water (scars) will continue to drip. Dr. Kerns suggests that patients with HS get laser hair removal early on after receiving a diagnosis.
- Topical antibiotics and oral medications, such as clindamycin and long-term antibiotics, are used to reduce inflammation and flare intensity, thereby decreasing the risk of scar formation in HS.
- In persistent or severe cases, surgical procedures like deroofing, excision, or wide skin excision are employed to remove tunnels, scar tissue, and abscesses, promoting healing and preventing new scar tissue development.
- Laser hair removal with long-pulsed Nd:YAG or alexandrite lasers can destroy hair follicles, reducing follicular occlusion and inflammation, making it useful in preventing flares and scarring.
- An elimination diet is recommended to identify and avoid personal dietary triggers that may worsen HS inflammation, thereby potentially minimizing scarring.
- Implementing stress management techniques, such as meditation, yoga, massage therapy, or counseling, can help manage chronic stress—a known trigger for HS flares and scarring severity, while quitting smoking and maintaining a healthy weight can further reduce HS severity and scarring risk.
