Hidradenitis Suppurativa Treatment: Chemical Peel

If you've been battling painful nodules, hidden tunnels and stubborn scars from hidradenitis suppurativa (HS) and wonder whether a chemical peel could fit into your care plan, you're not alone. Many people who have tried antibiotics, steroids, or surgery still search for that extra edge that might calm inflammation and smooth skin.

In short, certain peel formulas can help unclog pores, reduce redness and improve scar texture, but they are not a cure and they do come with real sideeffects. Below we'll walk through what HS is, why regular treatments sometimes fall short, how chemical peels work, what benefits you might see, the risks you need to watch for, and how to safely incorporate a peel into a broader HS treatment strategy.

Understanding HS

What is hidradenitis suppurativa?

HS is a chronic inflammatory skin condition that typically shows up in the armpits, groin, buttocks and under the breasts. It starts as small, painful bumps that can progress to deeper abscesses, draining tunnels (known as sinus tracts) and thickened scar tissue. The disease is staged using the Hurley system (IIII), with higher stages indicating more extensive tunneling and scarring.

Standard HS treatment options

Most dermatologists begin with a mix of medication, procedural interventions and lifestyle tweaks:

Category	Examples	Typical Use	Common Sideeffects
Medications	Oral antibiotics (tetracyclines), hormonal therapy, biologics (adalimumab, infliximab)	Reduce bacterial load & inflammation	GI upset, liver issues, increased infection risk
Procedures	Laser therapy, deroofing, widearea excision	Remove existing tunnels or nodules	Pain, scarring, delayed healing
Lifestyle	Weight management, smoking cessation, lowglycemic diet	Minimize flareups	Requires sustained effort

Even with these tools, many patients still experience flareups because the disease can be resistant to medication, or because surgical options carry their own recovery challenges.

How Peels Work

The science behind exfoliation

A chemical peel applies a solution of acids to the skin, accelerating the shedding of the outermost layer (the stratum corneum). This process clears clogged hair follicles, stimulates new collagen formation and can temper inflammatory pathways such as IL1 and TNF.

Peel agents studied for HSrelated skin issues

Peel Type	Active Ingredient	Typical Concentration	Known AntiHS Actions	Depth
Glycolic Acid	Alphahydroxy acid	2035%	Reduces keratin plugging	Superficial
Salicylic Acid	Betahydroxy acid	1030%	Antiseborrheic, antibacterial	Medium
Trichloroacetic Acid (TCA)	TCA	1525%	Collagen boost, scar remodeling	Mediumdeep
Jessner's Peel	ResorcinolLacticSalicylic mix		Broadspectrum exfoliation	Medium

Most of the data come from acne or rosacea studies, but a few small pilot trials have begun to look specifically at HS. For instance, a 2023 study published in Dermatology Research found a modest decline in lesion count after a series of monthly glycolicacid peels for stage III HS patients according.

Potential sideeffects

While many people tolerate peels well, the risks can include:

• Erythema and peeling usually temporary.
• Postinflammatory hyper or hypopigmentation more common in darker skin tones.
• Deep ulceration or infection rare, but possible if applied over active tunnels.

Benefits of Chemical Peels for HS

Unclogging follicles and preventing new nodules

By sloughing away the builtup dead skin cells, peels keep hair follicles open. This can limit the formation of new, painful nodules, especially in earlystage disease where the tunnels haven't yet formed.

Antiinflammatory effects

Some acids, especially salicylic and glycolic, have been shown to dampen inflammatory cytokines. In the same 2023 pilot study mentioned earlier, participants reported a 30% reduction in reported pain after three months of treatment.

Improving scar texture after surgery

Mediumdepth peels such as TCA can remodel collagen in existing scar tissue, making postoperative areas smoother and less noticeable. This is especially helpful for patients who have undergone deroofing or excision and are left with thick, raised scars.

Realworld example

Maria, a 34yearold with Hurley stage II HS, added a monthly 25% glycolicacid peel to her regimen after a year of antibiotics. Six months later, she noted about 30% fewer flareups and a noticeable softening of the scar tissue on her underarms. She credits the improvement to the regular "peelandclean" routine her dermatologist designed for her.

Risks & Contraindications

When a peel could worsen HS

If you have an active, draining tunnel or a recent surgical wound, a peel may irritate the area, trigger further inflammation, or even spread infection.

Pigment disorders

People with darker skin tones should be especially cautious. The acid can cause postinflammatory hyperpigmentation (PIH), which may be more cosmetically concerning than the HS lesions themselves. A patch test on a small area is strongly recommended.

Infection risk and delayed healing

Because peels temporarily disrupt the skin's barrier, there's a brief window where bacteria can enter. This is why clinicians advise waiting until all HS lesions are healed and not performing peels on open wounds.

Quick selfcheck checklist

• Do you have active draining tunnels? No proceed with caution.
• Have you taken antibiotics or steroids within the past two weeks? Consider waiting.
• Are you pregnant or breastfeeding? Discuss alternative options.
• Do you have a history of severe PIH? Choose lowstrength peels and conduct a patch test.

Integrating a Peel into Your HS Plan

Prepeel evaluation

Your dermatologist will assess skin type, HS stage, current medications and wound status. This evaluation ensures the chosen peel won't interfere with biologic therapy or exacerbate any open lesions.

Choosing the right peel

For earlystage HS (Hurley III) and patients with mild hyperpigmentation risk, a superficial glycolicacid peel (2030%) performed every 46weeks is often a safe starting point. Those seeking scar remodel after surgery might benefit from a mediumdepth TCA peel (1520%) done quarterly.

Aftercare routine

Good aftercare can make or break the outcome. Here's a simple checklist:

• Gentle, fragrancefree cleanser for the first 48hours.
• Apply a soothing, noncomedogenic moisturizer (look for ingredients like ceramides or hyaluronic acid).
• Use broadspectrum SPF30+ daily peels increase sun sensitivity.
• Monitor the treated area for excessive redness, swelling or signs of infection; contact your dermatologist if anything feels off.

Combining peels with other HS treatments

Peels can sit nicely alongside topical antibiotics or hormonal therapy, but you'll want to avoid applying a peel on the same day you receive an intralesional steroid injection. If you're on a biologic, many clinicians recommend spacing the peel at least two weeks apart from the biologic infusion to reduce overlapping immunosuppression.

Decisionmaking flowchart (text version)

Step1: Are you in an active flare with open tunnels?

Yes Hold peel, treat flare first. No Continue.

Step2: What is your skin type?

Light Superficial glycolic or salicylic peel can be tried. Dark Start with a lowstrength peel and patchtest.

Step3: Which HS stage are you?

StageIII Consider monthly superficial peel.
StageIII or extensive scarring Discuss mediumdepth peel after surgical healing.

Expert Insights & Evidence Gaps

Dermatology perspective

Dr. Laura Martinez, dermatology lead at Mayo Clinic, notes: "Chemical peels can be a helpful adjunct in earlystage HS, especially for patients who struggle with follicular obstruction, but they're never a standalone cure. A thorough clinical assessment is essential."

What recent research tells us

Two small pilot trials in 20232024 explored glycolicacid and salicylicacid peels in HS patients, reporting modest reductions in lesion counts and patientreported pain scores. However, sample sizes were under 30, and longterm safety data remain limited.

Where we still need answers

• Large, randomized controlled trials comparing peels to laser therapy.
• Longterm followup on pigment changes in diverse skin tones.
• Best timing of peels relative to biologic dosing schedules.

Putting It All Together

So, can a chemical peel be part of your hidradenitis suppurativa treatment plan? Absolutelyif it's chosen wisely, performed by a qualified professional, and paired with the rest of your care regimen. Think of a peel as a gentle "reset" button for clogged follicles and stubborn scar tissue, not a magic wand that erases the disease.

Before you jump in, have an open conversation with your dermatologist about:

• Your HS stage and current flare status.
• Your skin type and any history of pigment issues.
• Which peel formula and concentration would suit you best.
• How the peel will fit with any meds or procedures you're already doing.

Remember, every HS journey is unique. What works for one person might not work for another, and that's perfectly okay. The goal is to equip you with the knowledge to make informed choices, reduce pain, and feel a little more confident in your skin.

What do you think? Have you tried a peel, or are you considering it? Share your thoughts below, or reach out with any questionslet's keep the conversation going. Your experience could help someone else navigating the same path.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.