Scarring is a common problem in people with hidradenitis suppurativa (HS), often causing pain and limiting mobility, particularly in the armpits and groin. Even when HS is well-controlled, the scars remain. Beyond their physical impact, scars from HS can have a profound impact on a person’s self-esteem and social interactions, including romantic relationships and physical intimacy.

Scars are permanent, but treatments may help reduce their size and make them less noticeable. Over-the-counter (OTC) treatments may work for smaller scars, but more extensive scarring may require medical interventions. Treatment options include topical creams for mild scarring and more invasive procedures, such as surgery, for more severe HS scars.

More than 2,000 members of myHSteam report scarring as a symptom of their HS. Many members express frustration regarding how scars make them feel about their bodies. “I feel gross and unattractive,” one member wrote.

“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,” another member shared.

Members have also described how scars affect their interpersonal relationships. “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,” one member wrote.

Another member described the effect of HS on their 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.”

You can’t completely get rid of scars, but you can take steps to make them less bothersome and improve your quality of life. Read on to learn more about treatment options that might work best for your HS scars.

1. Injections

Corticosteroid (steroid) injections are among the most common treatments in dermatology to make scars smaller. Steroids are injected directly into the scar, reducing inflammation and slowing the production of collagen, a protein that makes up scar tissue. Research shows that corticosteroid injections can reduce a scar’s size by 50 percent or more. This treatment can also help ease itching or pain from scars.

Injections of fluorouracil or bleomycin (usually used as chemotherapy drugs) can also be used to reduce the size of raised scars and improve pain and itching. These treatments are injected into raised scar tissue, including keloid scars — thick, raised scars that people with HS may develop. Fluorouracil and bleomycin can be combined with steroid injections or laser therapy to help reduce potential side effects of swelling, dark spots, or purplish or red discoloration, depending on skin tone.

2. Pressure Dressings

Pressure dressings placed on wounds can prevent scar tissue, including keloid scars, from forming and spreading. The tight-fitting bandage, stocking, or sleeve may need to be worn for as long as a year and replaced every six to eight weeks. Some people may find pressure dressings uncomfortable, but they should be worn for the duration your doctor recommends so that they’re effective for preventing scars.

3. Topical Silicone

Topical silicone comes in several forms, making it appropriate for any part of the body. Medical-grade silicone ointments, gel sheets, bandages, and sprays work well for treating raised scars. Silicone sheets keep the scar hydrated and should be worn at least 12 hours a day for a few weeks or months. Silicone gel applied to skin dries quickly. Both OTC and prescription options are available.

4. Dermabrasion

For scars that don’t deeply penetrate the skin, dermabrasion is commonly used. The skin is numbed with a local anesthetic or freezing agent and then scraped with a wire brush tool or diamond wheel, which removes the scarred layers. Side effects include acne breakouts in the treated area, infection, and swelling. Dermabrasion may not be a good option if you have darker skin, which can be discolored by this treatment.

5. Chemical Peels

A chemical solution can be applied to the skin to remove scarred layers. Light chemical peels target the epidermis (outermost layer of skin). Medium and deep peels penetrate into the dermis (second layer of skin). Medium-strength peels typically contain 20 percent to 35 percent trichloroacetic acid (TCA) or 50 percent to 70 percent glycolic acid. Deep peels often involve phenol or higher concentrations of TCA, typically over 50 percent.

Side effects of chemical peels include skin discoloration, swelling, pain, and blisters that can last for weeks or months. The procedure may also cause skin to become darker or lighter, which can be permanent. This is more common for people who have darker skin.

You may need to stop taking certain medications, such as aspirin or glycolic acid, before undergoing a chemical peel. Light and medium peels may need to be repeated to get good results.

6. Surgeries and Procedures

Sometimes surgery may be needed to reduce or remove scars from HS. “I had a plastic surgeon remove the scars, and our medical aid paid for the procedure,” a myHSteam member wrote.

Surgery may also improve pain, itching, appearance, and movement of scars. Some procedures, such as scar revision and skin grafts, produce new scars, but these can be treated to minimize them.

Scar Revision Surgery

Surgical scar revision involves cutting out scar tissue and rejoining the skin. This can lead to a new but less visible scar, especially when combined with other scar-reducing therapies. Scar revision aims to improve appearance and range of motion in scars that make movement difficult.

Skin Grafts and Flaps

Skin grafts involve taking healthy skin from one area of the body and using it to cover areas that have scarring or skin damage. Skin flaps are similar, but the healthy skin remains attached to the blood vessels and is moved to a nearby area of skin.

Skin grafts are less complicated than flaps, but they may take more time to complete. The two main types are split skin grafts and full-thickness skin grafts. In a split skin graft, the top of the skin is “shaved” off, usually from the thigh. Full-thickness grafts require removing all three layers of skin from the upper arm or neck or around an ear.

Punch grafting can be an effective technique for small scars that are deep or form pits. The scar is removed with a skin punch and replaced with skin removed punched from a part of the body that isn’t noticeable, such as behind the earlobe.

Laser Therapy

Different types of laser therapy may help reduce scar appearance, lessen pain and itching, and improve the movement of tight or hardened scar tissue. A specific type of laser therapy, carbon dioxide (CO2) resurfacing, has shown improvements for HS lesions and can be helpful for HS scars. Lasers can be used to:

• Remove layers of raised scar tissue
• Help repair collagen
• Get rid of discoloration
• Prevent or minimize scar formation after surgery
• Be combined with injections of steroids or other medications

Laser treatment can cause darkening or lightening of skin as a side effect.

Cryotherapy

Cryotherapy, also called cryosurgery, freezes the scar and the surrounding area. It works similarly to laser therapy but uses cold instead of light and heat. Cryotherapy not only makes the scar smaller but also improves itching, pain, and discoloration. This technique is used less commonly for HS scars that also involve tunnels and nodules. Side effects include blistering, pain, or skin color changes.

Tips for Preventing or Reducing HS Scars

Some myHSteam members seek advice on how 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.

There’s no foolproof way to prevent scars from forming, but you can take steps like these to reduce scarring:

• Ward off HS flare-ups — Follow your doctor’s plan for treatment to reduce flare-ups. Preventing new lesions can keep new scars from forming.
• Keep wounds clean — Talk to your doctor about how to protect and cleanse wounds. Generally, you can wash them gently with mild soap and water.
• Apply sunscreen — Using SPF 50 (or higher) sunscreen can help prevent or improve dark discoloration of scar tissue.
• Discuss proper wound care with your dermatologist — One survey found that more than a third of dermatologists don’t counsel people on proper wound care for HS. Ask your doctor about how to dress your wounds, what type of clothing you should wear, and other ways to support the healing process and reduce scarring.

Some myHSteam members take a positive attitude regarding their scars. One member considers them badges of honor: “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!”

Talk With Others Who Understand

On myHSteam, the social network for people with hidradenitis suppurativa, more than 44,000 members come together to ask questions, give advice, and share their stories with others who understand life with HS.

What has been your experience with HS scars? What treatments do you use to reduce scarring? Share your experience in the comments below, or start a conversation by posting on your Activities page.