Blocked hair follicle? Recurrent skin issue scarring options (Photo)

Question

Hello doctors! Around October 2023 I had what I think was an inflamed or blocked hair follicle on my stomach. Since that time, the original lesion seems to heal, them becomes inflamed again and expands. The scarring is becoming horrible. What is this and what can I do to treat it and mitigate the scarring? It seems to have fibrous tissue or velours hairs inside. I am prone to ingrown hairs, but usually a dark hair emerges eventually.

Anna Chacon, MD, FAAD · Answer

It sounds like you might be dealing with a condition known as hidradenitis suppurativa (HS) or possibly recurrent folliculitis. Both conditions can cause inflamed or blocked hair follicles, leading to recurrent lesions, scarring, and the presence of fibrous tissue or hair within the lesions.

Hidradenitis Suppurativa (HS)
HS is a chronic skin condition characterized by recurrent, painful, inflamed lesions that typically occur in areas where skin rubs together, such as the armpits, groin, buttocks, and under the breasts. However, it can occur on the stomach as well.

Folliculitis
Folliculitis is the inflammation of hair follicles, which can be due to infection (bacterial, fungal), irritation, or blockage. It typically presents as small, red bumps, which can become pustules.

Steps to Take

1. **Consult a Dermatologist**
   - **Diagnosis**: A dermatologist can provide a definitive diagnosis through clinical evaluation and, if necessary, further tests such as a biopsy or culture.
   - **Treatment Plan**: They can recommend a tailored treatment plan based on the severity and specific characteristics of your condition.

2. **Topical Treatments**
   - **Antibiotics**: Topical antibiotics like clindamycin can help reduce bacterial infection.
   - **Antiseptics**: Benzoyl peroxide washes can help reduce bacterial load on the skin.
   - **Retinoids**: Topical retinoids might be used to help prevent follicular plugging.

3. **Oral Medications**
   - **Antibiotics**: Oral antibiotics such as doxycycline or minocycline can help with severe inflammation and bacterial infection.
   - **Anti-inflammatory Medications**: Medications like corticosteroids or immunosuppressants might be considered in severe cases of HS.
   - **Hormonal Therapy**: For some cases, especially if linked to hormonal factors, hormonal therapy might be beneficial.

4. **Procedural Interventions**
   - **Incision and Drainage**: For larger, painful lesions, a dermatologist might perform an incision and drainage.
   - **Laser Therapy**: Laser hair removal can reduce the occurrence of new lesions by removing hair follicles.
   - **Surgical Excision**: In severe, recurrent cases, surgical removal of the affected tissue might be necessary.

5. **Preventive Measures**
   - **Hygiene**: Maintain good hygiene and avoid tight clothing that can cause friction.
   - **Weight Management**: If applicable, weight loss can reduce skin friction and improve symptoms.
   - **Heat and Moisture**: Avoid prolonged exposure to heat and moisture, which can exacerbate the condition.

Managing Scarring
1. **Topical Treatments**: Silicone gels or sheets can help reduce the appearance of scars.
2. **Corticosteroid Injections**: These can help reduce keloid or hypertrophic scars.
3. **Laser Therapy**: Various laser treatments can improve the appearance of scars.
4. **Microneedling**: This can help remodel scar tissue and improve skin texture.
5. **Dermabrasion/Chemical Peels**: These can help smooth out the skin surface.

Given the chronic and recurrent nature of your symptoms, it's crucial to seek professional medical advice. A dermatologist will be able to diagnose the condition accurately and recommend a comprehensive treatment plan that addresses both the lesions and the scarring. Managing the underlying condition effectively will also help prevent future scarring.

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