Guide for Managing Scarring from Hidradenitis Suppurativa
Hidradenitis Suppurativa (HS) is a chronic inflammatory condition that can lead to the formation of cysts on and under the skin. If left untreated, these cysts can result in deep scars that can have a lasting impact on the appearance of the skin. However, effective methods exist to prevent and reduce the severity of these scars.
Controlling Active Inflammation and Infection
The key to managing HS-related scars is early and comprehensive control of inflammation, infection, and lesion progression. Topical and oral antibiotics are used to reduce infection and inflammation, limiting tissue damage and subsequent scarring. Steroid injections into painful areas can also help reduce swelling and inflammation.
Medical Therapies to Reduce Flare-ups
Hormonal therapy, retinoids, and biologics such as adalimumab are used to manage flare-ups and address symptoms like acne. Biologics, medications made from organic life, are being used to directly target specific inflammatory responses that cause HS cysts to form.
Lifestyle Measures
Minimizing friction and irritation is crucial in managing HS. This includes wearing loose-fitting, breathable cotton clothing, avoiding harsh scrubbing, waxing, and shaving techniques, maintaining a healthy weight, and using antimicrobial washes to reduce bacterial contamination.
Procedural Interventions for Lesion Management
Early, appropriate surgical procedures can significantly reduce extensive scarring. Unroofing or debridement removes tunnels and interconnected lesions, promoting healing. Laser therapy, such as Nd:YAG laser, can be used for lesion removal or laser hair removal to prevent recurrence of lesions in hair follicles. In severe or refractory cases, wide surgical excision with immediate or delayed skin grafting or flap coverage may be necessary.
Other Supportive Treatments
Botox injections have shown promise in improving HS symptoms and potentially reducing inflammation and sweating, which may indirectly reduce scar severity. Dermabrasion, microdermabrasion, and microneedling could potentially be used to treat HS scars, similar to how they are used for acne scars.
Preventing the Spread of Infection
Dr. Kerns advises bandaging any area that is oozing or has a discharge to prevent the spread of infection. If a cyst produces discharge, blood, or pus, it should be kept clean and disinfected, and moisturizing creams or ointments can be used to prevent the skin from drying out.
Starting treatment early to control active disease and combining medical, lifestyle, and surgical approaches is essential to prevent extensive scarring in hidradenitis suppurativa. Close collaboration with a dermatologist experienced in HS management is recommended for tailored treatment plans that minimize scarring risk.
It's important to note that while these strategies can help manage HS and reduce scarring, there isn't a known cure for HS. However, early treatment of flare-ups can help reduce the severity of the resulting scars. For many, these scars can be painful and itchy, causing emotional stress and low self-confidence. But with the right treatment and care, it's possible to manage HS effectively and reduce the impact of scars on daily life.
[1] Dr. Kerns, personal communication, 2022. [2] Smith, J. (2021). Hidradenitis Suppurativa: Understanding and Managing the Condition. American Academy of Dermatology. [3] National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2021). Hidradenitis Suppurativa. [4] European Academy of Dermatology and Venereology. (2020). Hidradenitis Suppurativa: Guidelines for Management and Treatment. [5] American College of Obstetricians and Gynecologists. (2019). Hidradenitis Suppurativa: A Review for Obstetrician–Gynecologists.
