Hidradenitis Suppurativa Can Leave Scars, and These Treatments Can Help
Hidradenitis SuppurativaYour Guide to Managing HS

How Hidradenitis Suppurativa Scars Are Treated

This skin condition can leave major scars, but the right treatment can dramatically minimize the effects.
How Hidradenitis Suppurativa Scars Are Treated
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Updated on January 2, 2025
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Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic inflammatory condition that causes painful lesions, or abscesses, to develop under the skin in areas such as the armpits and groin. HS lesions often repeatedly break open, releasing a foul-smelling liquid, and then heal. Some people also develop tunnel-like tracts under the skin, connecting the lesions to one another.

The cycle of opening, draining, healing, and tunneling can result in scarring that can interfere with the person’s range of motion.

“HS scars can be difficult to treat because they can be extensive and composed of different types of scars, including raised scars (keloids or hypertrophic scars), flat scars, tunneled or ropelike scars, pink scars, and/or brown scars,” says Jacqueline Watchmaker, MD, a fellow of the American Academy of Dermatology in practice at U.S. Dermatology Partners in Arizona.

HS scars often form in areas where the disease is still active, making them even harder to treat, says Anna Chacon, MD, a board-certified dermatologist based in Florida who works for MyPsoriasisTeam, a social network for people living with psoriasis or psoriatic arthritis.

Although HS scars can’t be removed completely, the right treatment can help make them less noticeable and restore ease of movement.

Treatment Options for Hidradenitis Suppurativa Scars

HS scars can look and behave differently from person to person. A dermatologist will consider factors including skin type and overall scarring before advising the best course of treatment.

Carbon Dioxide Laser Therapy

For extensive HS scars, most experts recommend carbon dioxide (CO2) laser therapy.

CO2 laser therapy removes small layers of skin with heat to help minimize scarring, sun damage, birthmarks, and other skin conditions.

It’s often used for keloids and hypertrophic scars from other skin conditions and injuries, says Dr. Watchmaker.

CO2 lasers use heat to vaporize microcolumns of skin to create “controlled injuries,” while causing minimal damage to surrounding areas. As these injuries heal, “The skin produces new collagen, which improves the texture of scars,” Watchmaker says.

For people with darker skin tones, including those in the Black, Asian, and Hispanic communities, the treatment can put them at risk of post-inflammatory hyperpigmentation, where dark patches or spots on the skin can appear after the skin is inflamed.

This is because darker skin has more pigment to begin with, and inflammation triggered by the light and heat of the laser can cause additional pigment to be created.

The signs of hyperpigmentation may not be permanent. Properly caring for the skin, including using ultraviolet protection when in the sun, can mean that it lessens over time.

If you have dark skin and are thinking of having CO2 laser treatment for any reason, find a board-certified dermatologist with training and experience treating your type of skin. “They’ll know how to adjust laser settings to be safe for different skin types,” Watchmaker says.

Surgical Removal

Surgery is recommended if tunnels have appeared beneath the skin or if a lesion or abscess keeps returning after treatment.

Removing tunnels beneath the skin can help smooth out skin and minimize the appearance of scars.

For certain scars, such as raised scars called keloids, surgery may be used in combination with other therapies to minimize the amount of scar tissue.

Surgery can result in new disease symptoms. One study found that about 31 percent of people who had complete excisions of the affected area ended up having a recurrence.

“If surgery is performed on active disease, it may help clear up that localized area,” Watchmaker says. “Often, however, cysts and new HS sinus tracts form around the area after surgery.”

When surgery is used to treat HS, it’s more likely to be done for active disease than for scar removal, Watchmaker says.

Steroid Injections

Some keloid scars, including those caused by HS, can be diminished with injections of a steroid called triamcinolone acetonide (Kenalog).

“Kenalog can be injected into firm, thick scars to help flatten them,” Watchmaker says. “It also can be used to calm inflammation in active disease.”

There is some preliminary evidence that combining triamcinolone acetonide with 5-fluorouracil (5-FU), an injectable cancer medication, may work better to minimize keloid scars and also help prevent them from coming back.

Complementary Therapies

If your scars aren’t very obvious and don’t interfere with your ability to function, you might consider a less aggressive treatment such as microneedling or massage.

Microneedling involves using tiny needles to puncture the skin and help stimulate the body to make more collagen. Collagen is a naturally occurring protein in the body that plays a key role in providing structure to the skin, helping new skin cells grow, and replacing dead skin cells.


It’s commonly used by dermatologists to diminish the signs of certain skin conditions, including scars, large pores, melasma, and sagging skin.

Massage therapy can be used to help with healing and reduce the pain and size of scars.

 Both stimulate the production of new collagen but are not considered to be the most effective treatment for HS scars.

Preventing Hidradenitis Supparativa Scars

The most effective way to deal with scarring from HS is to do your best to keep the active disease under control. The fewer lesions you have, the fewer there are that could morph into scars.

This means being aware of the symptoms of HS, which can be mistaken for acne, boils, or cysts. Seeing a dermatologist can help identify your symptoms and treat them accordingly, which may go a long way in helping to prevent unnecessary scarring.

“The most important thing to know about having HS scars and treatment options is to do your best to prevent them from occurring in the first place, says Dr. Chacon. “Once you recognize you have this disease, it is imperative to begin treatment with a dermatologist. Even if you’re not able to go in person, you can always see them virtually.”

The Takeaway

  • Hidradenitis suppurativa is a chronic inflammatory condition that causes painful lesions, abscesses, and/or tunnels to develop deep in the skin.
  • The skin condition can lead to scarring that can be painful and affect a person’s range of motion.
  • Treatments such as laser therapy or surgery can help reduce the size and appearance of scars.
Meet Our Experts
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Ross Radusky, MD

Medical Reviewer
Castle Connolly Top Doctor

Ross Radusky, MD, is a practicing board-certified dermatologist at the Dermatology Treatment and Research Center in Dallas. Originally from New York City, he graduated summa cum laude from the City University of New York and then received his MD from the New York University School of Medicine. There, he was inducted into the Alpha Omega Alpha Honor Medical Society and served as chapter president for two years. He completed his residency in dermatology at NewYork-Presbyterian Hospital and Weill Cornell Medical Center, and at Memorial Sloan Kettering Cancer Center.

Dr. Radusky practices general and cosmetic dermatology with a focus on the early detection of skin cancer, and provides patients with a personalized approach to looking their best at any age. He has authored articles and textbook chapters on the clues that our finger- and toenails may provide us about internal disease, as well as on comprehensive therapies for cosmetic dermatology and reversing the signs of skin aging.

Complementing his medical practice, Radusky has a strong passion for the cultural arts, particularly in expanding access to youths and seniors. He previously served as an artist instructor for the Rockaway Artists Alliance, a New York City nonprofit arts and education organization, and then served as both a board director and treasurer of the organization throughout his medical school training.

Radusky enjoys spending time outdoors with his wife Robyn, son Oliver, and poodle Lucy, where he can usually be found preventing photoaging and reducing the risk of skin cancer beneath an umbrella in a wide-brimmed hat. He is also the proud inventor of Sunshotz, the world’s only sunscreen measuring cup, designed to help patients of all ages apply the proper amount of sunscreen needed to enjoy all the sun without the burn.

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Michelle Konstantinovsky

Michelle Konstantinovsky

Author
Michelle Konstantinovsky is a Bay Area–based freelance journalist, marketing specialist, and ghostwriter. An alumnus of the University of California in Berkeley Graduate School of Journalism, she’s written extensively on health, body image, entertainment, lifestyle, design, and technology for outlets such as Vogue, Vanity Fair, Glamour, Shape, Self, Scientific American, Wired, and more. She served as a senior content writer at One Medical, the health and wellness editor at Fitbit, a contributing editor and the social media director at California Home + Design, and a content marketing consultant at Carrot Fertility. She is an avid admirer of shiny objects and early 2000s pop culture.
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Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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