How to Prevent and Treat Hidradenitis Suppurativa Scars, According to Dermatologists
If you have hidradenitis suppurativa (HS), then you know the lumps, abscesses, and fluid-filled bumps it can cause are a nightmare to deal with. And the aftermath is often worse. Because HS is a chronic inflammatory skin condition, the deep scars it can leave behind are no joke—you might find it hard to move easily, wear certain types of clothes, or just live a pain-free life.1
There’s an added layer of complexity if you’re a person of color. Black women, in particular, have a higher risk of HS. While anyone can develop darker areas after their skin is damaged or injured—known as post-inflammatory hyperpigmentation—this tends to be more noticeable in people who have more melanin, which is the substance that gives your skin its color.2,3 Destineé Spruell, 28, had her first HS lesion under her armpit at around 11 or 12 years old, and now she has scars in that area that are “very dark compared to [the rest of] my skin.”
Thankfully, there are ways to prevent and treat HS scars, but some approaches work better than others. Here’s what you need to know, according to the experts and people with HS we talked to.
1. See a dermatologist as early as you can.
HS lesions tend to go much deeper than your everyday wounds, Pooja Sodha, MD, assistant professor at George Washington School of Medicine and Health Sciences and director of the Center for Laser and Cosmetic Dermatology, tells SELF.4 Some people with the condition develop skin tunnels, also known as sinus tracts, which can open up, leak fluid, and cause scars. To slow that process down, you should ideally get started on a treatment plan as early as possible.
That can be easier said than done, given that shame, stigma, misdiagnoses, and a lack of health insurance (or other barriers to care) can delay treatment.5 On average, it takes doctors longer to accurately diagnose Black people with HS compared to white people—about five years versus three years, respectively.6 Shannon Marie Akins, now 29, experienced her first HS flare-up in her genital area and armpit when she was 13, but she was afraid to tell anyone because she wasn’t sure what was going on. After eventually talking about it with her mother, it still took a long time to figure out. “I was in and out of doctors for years,” she tells SELF.
You can’t control health care providers who dismiss and/or misdiagnose you—a lot of them may not recognize HS symptoms on darker skin tones, especially in the early stages—but if you think you have the condition, finding a dermatologist who knows how to treat people of color can be really validating.
Heather Woolery-Lloyd, MD, FAAD, a dermatologist who is the director of the Skin of Color Division for the University of Miami Department of Dermatology and an active member of the Skin of Color Society, tells SELF she spends a lot of time reassuring people that HS flare-ups aren’t their fault and encouraging them to get the specialized care they deserve—the sooner, the better. “HS is an extremely challenging skin condition,” she says. While there’s no quick fix or single approach that will help you avoid scars completely, early treatment can help, she says.
2. Try antibiotics and corticosteroids.
Common HS treatments, including antibiotics, anti-inflammatories, and hormonal medications like oral contraceptives can help tamp down and even prevent the inflammation that leads to scars.7 “The earlier you start, the less likelihood of scarring even becoming an issue,” Dr. Sodha says.
