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Hidradenitis Suppurativa (HS)

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What is Hidradenitis Suppurativa (HS)?

Hidradenitis suppurativa (HS), also referred to as acne inversa, is a chronic skin condition that affects the sweat glands and typically features the formation of small, circular lumps around hair follicles under the skin.1 

HS most commonly occurs in areas with many sweat glands, such the armpits, groin, and anal area. Affected areas can also include the inner thighs or, in females, underneath the breasts. HS can occur on one or multiple areas of the body.1 Hidradenitis suppurativa is often considered an extremely severe form of acne.

Why Does HS Develop?

Although the exact cause of HS development is unknown, the condition most likely results from a combination of genetic and environmental factors. People with hidradenitis suppurativa typically develop blocked or clogged apocrine glands, a subgroup of sweat glands.2 When the individual sweats, these blocked apocrine glands prevent sweat from escaping his or her body. Doctors do not know what causes these glands to become blocked. 

Although researchers ruled out poor hygiene and obesity as possible causes of hidradenitis suppurativa, obesity can worsen the symptoms of HS. Conversely, weight loss can improve (but not cure) the symptoms.3 In addition, HS may also worsen if the individual experiences a great deal of stress, hormonal changes, or excessive perspiration.1 HS is not contagious or sexually transmitted.2

Who Does HS Affect?

In most cases, hidradenitis suppurativa develops in teenagers and young adults who have recently experienced puberty. The condition generally worsens over time until the age of 55, at which point it declines in intensity.4 HS affects more women than men and develops more commonly in African Americans. In addition, people that have a prior history of acne often have a higher risk of developing hidradenitis suppurativa.2

Currently, severe HS affects about 1 to 4 percent of individuals worldwide.5 When milder cases are also considered, recent studies show that HS affects at least 1 in 100 people.6

Symptoms

Early diagnosis and treatment of HS are vital for managing symptoms and may help prevent further progression. If you have any of these symptoms, please consult your doctor!

Hidradenitis suppurativa causes long-term skin inflammation and can be very painful. Typically, the initial symptoms include one or more painful bumps that may be red and similar in appearance to pimples. HS has also been said to look like deep-acne blackheads, folliculitis, or boils.7 

If hidradenitis suppurativa worsens, these painful, pimple-like bumps can grow bigger and more inflamed, sometimes resulting in the formation of tunnels underneath the skin that connect the bumps.1 If HS remains untreated, the bumps will grow more inflamed until they eventually rupture.7 After the initial symptoms appear, it may take anywhere from a few hours to many days for these lesions to enlarge and rupture. The pain from these bumps and ruptures may persist for months.1 Following these ruptures, abscesses caused by the HS may leak foul-smelling pus from the affected area until the healing process begins.

During the healing process of the abscesses, scars can appear and tunnel-like tracts can develop beneath the skin. As the healing process continues, the scars thicken and make it difficult to move limbs or even walk, depending on the location of the scars. Individuals with HS typically must live with on-going periods of flare and remission for years.3

Additional symptoms may include:

  • Itching
  • Foul odor
  • Scarring
  • Leaking clear or yellow fluid
  • Painful bumps or sores in armpits, groin, between the buttocks, and/or under the breasts
  • Difficulty moving limbs or walking3 

When to See a Doctor

Since hidradenitis suppurativa is often similar in appearance to acne, folliculitis, or boils, it is best to consult a dermatologist for an accurate diagnosis and proper treatment if you think you may have this condition. In many mild cases of HS, symptoms can be greatly improved with self-care treatments. However, more severe cases of HS must be treated with the consult of your doctor.

It may be wise to consult your doctor if any of the following occur:

  • Bumps/scars are painful
  • The condition does not improve within a few weeks
  • Bumps return within weeks following treatment
  • Bumps/scars appear in multiple locations
  • The condition recurs often1

When Speaking to Your Doctor

When you meet with your doctor, he or she will most likely begin by asking you numerous questions about your condition. These questions may involve the start, progression, appearance, and pain level of your symptoms. A doctor may also ask if you or a family member have ever experienced this problem previously.1

Before your appointment takes place, there are several steps you can take to ensure that you provide your doctor with the most accurate information and receive the most effective treatment. One step consists of writing down all of the signs and symptoms that you have experienced, including the duration, appearance, and pain level of bumps or lesions, prior to your visit.1

Additionally, especially if you are going to a new healthcare provider, it is important to make a list with the dosages and directions for all of the current medications you are taking. For some, it may be more convenient to just bring the original medication bottles to your appointment.1

Please note that talking to your doctor should not be a one-way relationship. If you are seeing a new doctor for the first time, it is acceptable to interview your doctor to ensure that he or she meets your specific needs before any treatment is given.8 Do not hesitate to ask questions if you do not understand something your doctor has said or if you have other concerns. It may be useful to prepare some questions before your appointment as well.

When speaking to your doctor about HS, some questions to ask that may be helpful include:

  • Do I have hidradenitis suppurativa?
  • What would be the best treatment for me?
  • Should I make any lifestyle changes?
  • Could there be any side effects from taking my medication?
  • Could the condition fully improve on its own?
  • Should I lose weight?
  • Will taking zinc supplements help improve my symptoms?
  • What should I do if my symptoms get worse?2

Treatment

There is no cure for hidradenitis suppurativa.2 However, with a proper diagnosis from your doctor, HS can be medically controlled through different treatments. The type of treatment one should receive for hidradenitis suppurativa depends on the severity of the condition.

Typically, mild cases of HS can be treated with self-care methods such as applying warm compresses to the affected area and cleaning it with anti-bacterial soap.2 In these cases, anti-inflammatory medications (such as Advil) can be taken to help manage pain and swelling and, for some women, high-estrogen birth control pills can be beneficial in improving symptoms.2 Along with this, topical antibiotics may be applied to the skin as an initial treatment.3

If the case is more severe, the individual may need corticosteroids injected directly into the affected area to reduce inflammation and tenderness. This treatment is usually effective within a few days.1

Another treatment option that may be necessary for more severe or persistent cases is surgery. There are three main types of surgical procedures that may be utilized to treat hidradenitis suppurativa based on the severity of the condition:

  1. Incision and drainage: Typically used for milder cases or smaller affected areas, incision and draining is considered a short-term relief treatment for hidradenitis suppurativa.  For this procedure, incisions are made to cut into the abscesses and drain out the pus, temporarily relieving the individual from pain and inflammation. Wounds from the incision procedures usually take about 1 to 2 weeks to heal, depending on the size of the abscess. There is a high reoccurrence rate of HS after utilizing this treatment.
  2. De-roofing: Used for mild to moderate cases of hidradenitis suppurativa, the procedure known as de-roofing involves more surgical cutting than does the incision and drainage treatment. In this procedure, a surgeon removes the flesh that is covering any interconnected tunnels that may have formed underneath the skin. By removing the “roof” of these abscesses, the pus is able to drain and the healing of the abscesses is accelerated. However, even with the de-roofing treatment, HS may reappear in the treated area or another area of the body.
  3. Full surgical removal: If neither of those treatments are successful or the case involves severe symptoms, a more intense treatment for hidradenitis suppurativa involves full surgical removal of all affected skin. Depending on the size and depth of the affected area being removed, a skin graft may be needed to close the wound. Although full surgical removal can treat the hidradenitis suppurativa that is present in an affected area, it does not prevent the occurrence of HS in other areas of the body.

Since surgery may have complications, medical treatments are often prescribed first.1

Prevention

Unfortunately, there are no guaranteed methods for preventing flare-ups of hidradenitis suppurativa. However, the following suggestions may help to prevent flare-ups and the spreading of the condition:

  • Keep the affected area clean by washing with anti-bacterial soap
  • Wear loose-fitting clothing to avoid skin irritation
  • Lose weight
  • Avoid synthetic clothing that may irritate your skin
  • Avoid humid climates
  • Do not shave or use deodorant on affected areas
  • Avoid stress
  • Eat healthy and exercise
  • Make sure to get a proper amount of sleep each night
  • Ask your doctor about taking zinc supplements2

 

Support

In many cases, recurrent hidradenitis suppurativa can lead to self-consciousness, social isolation, and depression.6 HS can also lead to feelings of embarrassment or anxiousness. Oftentimes, the persistent nature of the condition can be burdensome.1 There are various forms of mental and emotional support available for an individual that has been affected by HS.

If you have been affected by HS, friends and family can be an incredible source of support to help you through this difficult time. In addition, professional counseling may be useful to discover various coping strategies and to provide additional support regarding your situation.1 

Please be aware that, although you may feel isolated, you are not alone. Online support groups are available for individuals suffering from HS.1 Speaking with others that understand your experiences can be especially comforting.

References

  1. "Hidradenitis Suppurativa." Mayo Clinic. Mayo Foundation for Medical Education and Research, 09 Apr. 2013. Web. 04 Feb. 2016.
  2. "Hidradenitis Suppurativa." Family Doctor. American Academy of Family Physicians, Mar. 2014. Web. 04 Feb. 2016.
  3. "Hidradenitis Suppurativa." American Osteopathic College of Dermatology (AOCD). American Osteopathic Association, n.d. Web. 04 Feb. 2016.
  4. "Hidradenitis Suppurativa." MedlinePlus. U.S. National Library of Medicine, 15 Jan. 2016. Web. 04 Feb. 2016.
  5. "Hidradenitis Suppurativa Foundation." Hidradenitis Suppurativa Foundation. N.p., n.d. Web. 04 Feb. 2016.
  6. "Hidradenitis Suppurativa." Genetics Home Reference. U.S. National Library of Medicine, 01 Feb. 2016. Web. 04 Feb. 2016.
  7. "Hidradenitis Suppurativa." American Academy of Dermatology. American Academy of Dermatology, n.d. Web. 04 Feb. 2016.
  8. "Questions to Ask Your Doctor." Certification Matters. American Board of Medical Specialties, n.d. Web. 04 Feb. 2016.

Last Updated 28 February 2016.