# HS Scars: What They Mean and What Can Be Done

Canonical URL: https://www.acneinversa.life/en/blog/hs-scars/
Markdown URL: https://www.acneinversa.life/en/blog/hs-scars.md
Plain text URL: https://www.acneinversa.life/en/blog/hs-scars.txt
Language: en
Category: Treatments
Published: 2026-09-03
Last updated: 2026-09-03
Last editorially reviewed: 2026-09-03
Next scheduled review: 2027-09-03
Evidence strength: Limited evidence — Rests mainly on case series, preliminary studies, or expert consensus.
Author: Dr. rer. nat. Dennis Alexander Kwiatkowski (Biochemist, Scientific Writer and Pharma Expert)
Scientific editor: Dr. rer. nat. Dennis Alexander Kwiatkowski
Reviewer qualifications: Biochemist, Scientific Writer and Pharma Expert
Review scope: Scientific literature, clinical guidelines, sources, and editorial clarity
Clinical reviewer: No independent clinical review
Tags: Acne Inversa, Hidradenitis Suppurativa, HS, Treatments, HS scars, atrophic scars, hypertrophic scars, scar treatment, tunnels vs scars, care navigation

> Hidradenitis suppurativa can leave permanent skin changes after inflammation settles. Learn how scars differ from active tunnels, what can look like a scar without being one, and what dermatology can realistically offer.

Medical disclaimer: This website is for general educational information only and does not replace medical advice, diagnosis, or treatment. Please speak with qualified medical professionals about symptoms or treatment decisions.

## 60-second summary

- Repeated HS inflammation can leave permanent scars — flat, depressed, thick, raised or rope-like.
- A repeatedly draining or newly painful area may still be an active tunnel, not old scar tissue.
- Dark or light marks after inflammation are pigment changes, not necessarily structural scarring.
- Extensive scarring can sometimes tighten skin enough to restrict movement, especially at the armpits or thighs.
- HS-specific evidence for scar treatments is still limited — there is no single 'HS scar' fix.

**What this means:** Knowing whether an area is settled scar tissue or still-active disease changes what, if anything, should be done about it — and that distinction usually needs an exam, not a guess.

**What we are less certain about:** Direct HS-specific research on scar treatment is recent and small. How much a given scar can realistically change is not predictable from a description alone.

**What you can do next:** Note when a scarred area last changed, drained or hurt, and how that differs from your usual flares, before your next appointment.

## Article

Hidradenitis suppurativa can leave permanent changes in the skin even after an inflamed area finally settles down. Some of these changes are flat and barely noticeable. Others are thick, firm, or rope-like, and in extensive cases they can tighten the skin enough to make movement uncomfortable.

But not everything left behind by HS is simply a scar. A lump, opening, or hardened area can sometimes still be active disease — a tunnel beneath the skin — rather than tissue that has actually finished healing. Treating a scar and treating active HS are different problems, and confusing one for the other is a common, understandable mistake.

This guide covers what is known about HS scarring: what it can look like, how it differs from an active tunnel, what dermatology can realistically offer, and what is worth raising at an appointment.

## Why does HS cause scars?

HS repeatedly inflames tissue around hair follicles in skin folds. Lesions enlarge, sometimes open and drain, heal, and often return in the same spot. Over years, that cycle of damage and repair can permanently change the structure of the skin.

The American Academy of Dermatology (AAD) describes this directly: healed HS skin scars, and years of repeated flare-ups can produce scars thick enough to limit movement ([AAD, *Hidradenitis suppurativa: Signs and symptoms*](https://www.aad.org/public/diseases/a-z/hidradenitis-suppurativa-symptoms)). Mayo Clinic similarly lists ropelike scars and pitted skin among the long-term effects of HS, noting that the resulting scar tissue can cause limited or painful movement, especially where the disease affects the armpits or thighs ([Mayo Clinic, *Hidradenitis suppurativa*](https://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/symptoms-causes/syc-20352306)). Germany's federal health portal, gesund.bund.de, describes the same pattern: in severe, longstanding disease, scar formation can become extensive enough that scar contracture restricts mobility ([gesund.bund.de, *Acne inversa*](https://gesund.bund.de/akne-inversa)).

Not everyone with HS develops extensive scarring — the disease course varies a great deal between individuals, and no one can predict from the outside how much scarring a particular person will end up with.

## What can HS scars look like?

There is no single "HS scar." Different mechanisms of damage leave different kinds of marks.

**Flat or discoloured areas.** After inflammation settles, skin often stays darker or lighter than it was. This is a pigment change, not necessarily structural scar tissue, and the two need different approaches if they bother you.

**Depressed or pitted scars.** Some healed areas sit visibly below the surrounding skin. These are usually described as atrophic scars. A small 2025 study specifically compared two procedures — fractional carbon dioxide laser and fractional radiofrequency microneedling — for HS-associated atrophic scars, which shows this is now an area of direct clinical interest, though the evidence is still limited (according to PubMed, [Eskibozkurt et al., *Journal of the American Academy of Dermatology*, 2025](https://doi.org/10.1016/j.jaad.2025.08.093)).

**Thick or raised scars.** Repeated inflammation, or surgery, can leave firm, raised tissue. "Hypertrophic scar" and "keloid" describe particular patterns of raised scarring, but the terms are not interchangeable, and telling them apart matters for treatment — that needs clinical assessment, not a description.

**Rope-like or bridged scars.** Long-standing disease in skin folds — classically the armpits — can leave thickened bands and bridges of scar tissue that visibly change the surface and flexibility of the skin.

**Scars after surgery.** Deroofing, excision, and reconstructive procedures intentionally replace diseased tissue with a wound that then becomes a scar. What that scar means depends on the procedure, how the wound was closed, how recently it happened, and whether it has fully healed — our guide to [wound healing after HS surgery](/en/blog/wound-healing-after-hs-surgery-first-90-days/) covers that timeline, and our comparison of [secondary intention versus flap closure](/en/blog/secondary-intention-vs-flap-closure-hs-excision/) covers how the closure technique itself shapes the resulting scar.

## Scar, tunnel, or still-active HS?

This is the distinction that matters most on this page.

A scar is tissue left behind once an area has actually finished healing. A tunnel — a sinus tract — is a channel of ongoing disease beneath the skin. From the outside, a firm or rope-like area can look similar whether it is one or the other, and there is no reliable way to tell them apart yourself by touch or appearance.

Our [Visual Guide](/en/what-hs-can-look-like/) illustrates both patterns separately — scarred skin, a tunnel beneath the surface, and areas where scarring and an underlying tunnel occur together — specifically because they are easy to conflate and clinically important to distinguish.

Bring an area back to your care team, rather than assuming it is "just an old scar," if it:

- starts draining again, even a little;
- becomes newly tender or painful;
- swells or reopens;
- has new inflammatory lumps developing around it;
- is visibly changing in size, shape, or texture.

## Can HS scars restrict movement?

Yes, and this deserves to be treated as a functional problem, not only a cosmetic one. Both the AAD and Mayo Clinic specifically describe extensive HS scarring as capable of limiting movement, with the armpits and thighs named as the areas most affected ([AAD](https://www.aad.org/public/diseases/a-z/hidradenitis-suppurativa-symptoms); [Mayo Clinic](https://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/symptoms-causes/syc-20352306)).

If this applies to you, describing the function matters more than describing the appearance. *"The skin in my armpit feels tight and I can no longer raise my arm as far as I used to"* gives your clinician something concrete to examine. *"I don't like how this scar looks"* does not carry the same clinical weight, even though both concerns are legitimate.

If a permanent movement restriction like this also affects your participation in daily life or at work in Germany, our guide to [HS, GdB and severe disability in Germany](/en/blog/hs-disability-germany-gdb/) explains how that assessment weighs functional consequences like this one.

## Can HS scars fade or go away?

Some changes soften with time. Others are permanent. How much a particular scar changes depends on how deep the original tissue damage was, the type of scar, its location, whether the same area keeps re-inflaming, and individual healing biology — none of which a website can assess for you.

Be especially cautious of any product or remedy claiming it can "remove" HS scars. Structural scar tissue is not the same as surface dryness or ordinary pigmentation, and it does not respond the same way to creams or exfoliants.

## Can HS scars be treated?

Sometimes — but the honest starting point is that HS-specific evidence for scar treatment is still thin, and there is no single "HS scar treatment."

Two questions shape what is reasonable to discuss:

1. **What are you trying to improve?** Appearance, colour, thickness, pain, tightness, restricted movement, and a post-surgical scar are different problems with different solutions.
2. **Is the area actually inactive?** A scar-directed procedure only makes sense once active disease nearby has been ruled out.

### Laser and energy-based procedures

Different laser and light-based procedures serve different goals in HS care, and it is easy to conflate them. Some target active follicular disease; others are aimed at established scar tissue.

A 2025 systematic review of laser and light-based HS treatments found supporting evidence for several modalities — including long-pulsed Nd:YAG, fractional CO₂, and intense pulsed light combined with radiofrequency — and specifically noted that ablative approaches such as fractional CO₂ and IPL-radiofrequency can also improve scarring alongside their effect on active lesions. The review's authors were clear that the underlying studies were small and highly varied in design, and called for standardized protocols and larger randomized trials (according to PubMed, [Jafarzadeh et al., *Lasers in Medical Science*, 2025](https://doi.org/10.1007/s10103-025-04722-2)).

The small 2025 comparison of fractional CO₂ laser against fractional radiofrequency microneedling for HS-associated atrophic scars mentioned above is a further, direct step toward HS-specific scar evidence (according to PubMed, [Eskibozkurt et al., 2025](https://doi.org/10.1016/j.jaad.2025.08.093)). It is not, on its own, enough to recommend either approach over the other — that is a discussion for an experienced dermatologist familiar with your skin and your disease activity.

### Treating thick or raised scars

Dermatology uses several approaches for hypertrophic scars and keloids in general, including injections and various procedural techniques. A large 2025 systematic review of postoperative scar treatments — 214 studies covering more than 11,000 treated scars and 49 different interventions — found that multiple approaches, including silicone-based products, injectable treatments, and several laser types, showed efficacy, but that protocols and outcomes varied so widely across studies that the evidence supports an individualized, tailored approach rather than one universally "best" treatment (according to PubMed, [Kodumudi et al., *Journal of Cosmetic and Laser Therapy*, 2025](https://doi.org/10.1080/14764172.2025.2605358)).

That review is general scar evidence, not HS-specific evidence. It is useful for understanding what dermatology has to offer for raised scars broadly, but it should not be read as proof that any one option works equally well on HS scars specifically.

### When surgery is part of the picture

Sometimes what looks like "a scar" is really part of an area with extensive old tunnels and fibrosis. In that situation, the relevant question usually is not cosmetic scar revision — it is whether structural disease in that area needs surgical treatment. If surgery is already being discussed with your team, our [HS Surgery Planner](/en/hs-surgery-planner/) can help you organize that conversation; this article is not the place to decide whether you need it.

## What about dark or light marks after HS?

Dark marks left after inflammation can be post-inflammatory hyperpigmentation, and lighter patches can also remain — neither is necessarily a structural scar, and they can occur alongside true scarring or on their own. Because pigment changes and structural scars respond to different approaches, treating a pigment change as if it were a scar (or the reverse) can waste time and, with harsh products, damage skin further.

Do not use bleaching agents, acids, or other aggressive products on HS skin that is actively inflamed, broken, or still healing without discussing this with a clinician first.

## A note on a scar that keeps changing

Most scars, once formed, are stable. Very rarely, chronically inflamed and scarred HS skin — particularly in the gluteal, perineal, or perianal region after years of disease — has been associated with skin cancer developing within it. This is uncommon, and it is not a reason for alarm about ordinary scars. But a scarred or chronically wounded area that is newly enlarging, ulcerating, or behaving differently from your established pattern is a reason for direct clinical examination rather than an assumption that "it's just an old scar acting up." Our guide on [when a chronic HS wound changes](/en/hs-chronic-wound-change-skin-cancer/) covers this specific warning sign in more detail.

## Can scarring be prevented?

No approach can guarantee HS will heal without scarring. The most defensible general principle is that reducing repeated inflammatory damage — by keeping active disease as controlled as possible — is the closest thing to a prevention strategy the evidence supports. That is not the same as saying scarring is avoidable for everyone, and it does not mean that someone who already has scars failed to manage their disease well enough. Scarring is a feature of how HS-affected skin heals, not a verdict on self-care.

## When should I bring a scarred area to my care team?

Worth raising specifically — not folded into a general "my HS is worse" comment — if the area:

- is still draining, even intermittently;
- has become newly painful or swollen;
- has new inflammatory lumps forming near it;
- is restricting movement or causing functional difficulty;
- is enlarging, ulcerating, or otherwise changing in a way that is new for you;
- is a post-surgical scar that is not healing the way your surgical team described.

## Questions to bring to your appointment

- Does this look like inactive scar tissue, active disease, or both?
- Is there any evidence of a tunnel underneath this area?
- What type of scar is this, and does that change what's realistic?
- Is my HS controlled enough right now to discuss scar-directed treatment here?
- Which of my concerns — appearance, tightness, pain, movement — are most likely to improve?
- Would a referral to a procedural dermatologist or surgeon add anything in my case?

## The bottom line

HS scars are not all the same, and neither is what should be done about them. Some are purely cosmetic; others contribute to pain or restricted movement; and sometimes what looks and feels like a finished scar is still active disease. The most useful first step is not searching for the strongest scar treatment — it is working out, with a clinician who can actually examine the area, what kind of change this is and whether anything nearby still needs treating. That question is worth answering properly before any conversation about scar-directed treatment even starts.

If body image and how HS scarring affects the way you feel about yourself is part of what you're dealing with, our article on [shame and body image with HS](/en/blog/shame-body-image-acne-inversa/) addresses that directly, and our [directory of HS-experienced clinicians](/en/hs-specialists/) can help you find someone to examine a change like this in person.

## FAQ

### Are HS scars permanent?

Some structural scars are permanent, though their colour, firmness and appearance can keep changing for a long time after the skin first closes. How much a particular scar improves varies considerably and cannot be predicted from a description.

### Can HS scars disappear completely?

Be cautious of anything promising full removal. Some procedures can improve specific scar features — texture, colour or thickness — but returning scarred skin to exactly how it looked before is generally not realistic.

### Is a tunnel the same thing as a scar?

No. A tunnel (sinus tract) is a channel of active disease beneath the skin; a scar is tissue left behind once an area has actually healed. They can sit in the same spot, and only a clinical exam can reliably tell them apart.

### Can lasers treat HS scars?

Some laser and radiofrequency procedures are used on scars generally, and a small 2025 study compared two such approaches specifically for HS-associated atrophic scars. Whether any procedure is appropriate depends on the scar type, disease activity, and skin characteristics — this article does not recommend a specific device.

### Should active HS be dealt with before cosmetic scar treatment?

That is a question for your dermatologist, not something a website can answer generically. An area needs to be confirmed as genuinely inactive before a scar-directed procedure is likely to make sense there.

### Can HS scars restrict movement?

Yes. Both the American Academy of Dermatology and Mayo Clinic describe extensive scarring as capable of causing limited or painful movement, particularly when it affects the armpits or thighs.

### Does having scars mean I did something wrong?

No. Scarring is part of how skin heals after repeated inflammation in HS. It reflects the disease process, not a failure of self-care.

## References

1. Hidradenitis suppurativa: Signs and symptoms - American Academy of Dermatology, aad.org - https://www.aad.org/public/diseases/a-z/hidradenitis-suppurativa-symptoms
2. Hidradenitis suppurativa - Symptoms & causes - Mayo Clinic, mayoclinic.org - https://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/symptoms-causes/syc-20352306
3. Acne inversa: causes, symptoms, treatment - gesund.bund.de (Bundesministerium für Gesundheit) - https://gesund.bund.de/akne-inversa
4. Prospective cohort study comparing hidradenitis suppurativa-associated atrophic scar treatments: Fractional carbon dioxide laser versus fractional radiofrequency microneedling - Journal of the American Academy of Dermatology, 2025 - https://doi.org/10.1016/j.jaad.2025.08.093
5. Systematic review of laser and light-based procedural treatments for hidradenitis suppurativa - Lasers in Medical Science, 2025 - https://doi.org/10.1007/s10103-025-04722-2
6. Postoperative scar treatment modalities: a systematic review of randomized controlled trials - Journal of Cosmetic and Laser Therapy, 2025 - https://doi.org/10.1080/14764172.2025.2605358