Everything You Should Know About Hidradenitis Suppurativa

Hidradenitis suppurativa is a condition of the skin that takes many forms, including small, pimple-like bumps, deeper acne-like nodules, or even boils.
The lesions are usually painful and appear in areas where skin rubs together, such as your armpits or groin. Scars and tracts can develop under your skin after these lesions heal.
This chronic condition affects up to 4 percent of the population. It can worsen over time and impact your daily life.
Read on to learn more about hidradenitis suppurativa and how you can manage its symptoms.

Symptoms

Symptoms

The main symptom of hidradenitis suppurativa is a painful skin breakout that commonly occurs on any of the following areas:

• armpits
• groin
• anus
• inner thighs
• under the breasts
• between the buttocks

Signs of a hidradenitis suppurativa breakout include:

• red, pimple-like bumps
• pain
• deep nodules or cysts
• boils
• draining nodules

Over time, if hidradenitis suppurativa goes untreated, your symptoms can worsen, and you may develop:

• tunnels, which are tracts or channels that connect lumps and form under your skin
• painful, deep breakouts that go away and come back
• bumps that burst and leak a foul-smelling pus
• scars that thicken
• scars that form as persistent breakouts
• infections

Lesions can come and go, but some people always have breakouts on their skin.
The following may worsen the condition:

• stress
• hormonal changes
• heat
• smoking tobacco products
• being overweight

Hidradenitis suppurativa vs. pimples, boils, and folliculitis

The hidradenitis suppurativa bumps are often mistaken for pimples, boils, or folliculitis. You can recognize a hidradenitis suppurativa breakout because it typically causes bumps on both sides of your body that tend to return in specific locations, such as your armpits and groin.

Photo of hidradenitis suppurativa

Causes

Causes

Doctors aren’t sure what causes hidradenitis suppurativa. What is known is that hidradenitis suppurativa isn’t contagious and isn’t caused by poor hygiene or any type of infection.
A family history is reported in one-third of people with the condition, suggesting that there may be a genetic link. Some studies have looked at mutations in specific genes and found a connection to hidradenitis suppurativa, but more research is needed.
An overactive immune system is another possible cause.
Hidradenitis suppurativa usually occurs shortly after puberty, so hormones are also likely involved in the development of the condition.

Risk factors

Risk factors that may increase your chances of developing hidradenitis suppurativa include:

• being a woman
• taking certain medicines, such as lithium
• being overweight or obese
• having a family history of hidradenitis suppurativa
• being between ages 20 and 29 years old
• having severe acne, arthritis, Crohn’s disease, inflammatory bowel disease, metabolic syndrome, or diabetes
• being a smoker

Diagnosis

Diagnosis

Getting diagnosed early on is important to ensure you receive effective treatment. This may prevent scarring and limitations of mobility, which can occur after ongoing breakouts.
If you suspect you have hidradenitis suppurativa, it’s a good idea to see a dermatologist. A dermatologist is a doctor who specializes in skin disorders.
Your doctor will examine your skin closely and may swab some of your lesions if they’re leaking fluid.
You should see a dermatologist if you develop breakouts that are:

• painful
• don’t improve within a few weeks
• appear in several locations on your body
• return often

Treatment

Treatment

While there is no cure for hidradenitis suppurativa, effective therapies are available. Treatment can:

• improve pain
• reduce the severity of breakouts
• promote healing
• prevent complications

Your doctor may recommend the following treatments:
Antibiotics: These medicines can reduce inflammation, treat infections, and stop new breakouts.
Biologics: The U.S. Food and Drug Administration has approved the biologic medicines adalimumab (Humira) and infliximab (Remicade) for the treatment of hidradenitis suppurativa. Biologics work by suppressing your immune system.
Steroids: Oral or injected steroids can reduce inflammation and improve your symptoms. Long-term use may lead to serious side effects.
Pain medications: Over-the-counter pain relievers may help relieve discomfort that’s caused by skin breakouts.
Hormones: Some small studies have shown hormone therapy may be as effective as antibiotics at treating sores, but more research is needed.
Metformin (Glucophage): This diabetes drug may also help people with hidradenitis suppurativa who also have metabolic syndrome.
Retinoids: These medicines come from vitamin A and may be used orally or topically.
Methotrexate: This medicine is typically reserved for treating severe cases of hidradenitis suppurativa.
Bleach baths: Taking a bleach bath may help get rid of bacteria that colonize on your skin. To use a bleach bath:

1. Add approximately 1/3 teaspoon of 2.2 percent household bleach for every 4 cups of water in your bath.
2. Soak in the bath for 10–15 minutes, keeping your head above water.
3. After your bath, rinse in warm water and pat yourself dry with a towel.

Acne washes or topical medications: While these products may not clear your symptoms on their own, they may be a helpful addition to your treatment regimen.
Zinc: Some people report improvement in symptoms when they take zinc supplements.
Sometimes surgery is performed to drain or remove lesions that grow deep in the skin. Other procedures to treat hidradenitis suppurativa include radiation, laser therapy, and unroofing. Unroofing is an operation that involves cutting away the skin that covers tunnels.
Your treatment plan will depend on the severity of your condition. You may need to try more than one therapy or change treatments over time.

Complications

Untreated or severe cases of hidradenitis suppurativa can cause complications, such as:

• Scarring: Scars can form where breakouts heal and then reappear. They can thicken over time.
• Immobility: Painful sores and scars may restrict your movement.
• Infection: Areas of your skin that drain or ooze can become infected.
• Lymph drainage problems: Bumps and scars typically occur on areas of your body that are near lymph nodes. This can affect lymph drainage, which may cause swelling.
• Skin changes: Certain areas of your skin may appear pitted or darker.
• Depression: The skin breakouts and unpleasant odor from drainage can lead to self-induced social isolation. As a result, some people become depressed.
• Fistulas: The healing and scarring cycle that’s associated with hidradenitis suppurativa breakouts can cause hollow passages, known as fistulas, to form inside your body. These can be painful and may require surgery.
• Skin cancer: Although very rare, some people with advanced hidradenitis suppurativa have developed a type of skin cancer known as squamous cell carcinoma on areas of the skin where they had breakouts and scarring.

Outlook

Outlook

Living with hidradenitis suppurativa can be challenging, but effective therapies may help reduce pain and improve your condition.
Improved treatment options may soon be available as researchers continue to search for new breakthroughs