Understanding Hidradenitis Suppurativa

People often mistake HS for an STD, but it’s not contagious. It’s also not caused by poor hygiene. A person’s body is reacting to its hair follicles.

In Hurley stage 2, there are multiple or extensive sinus tracts, abscesses, and scarring in a large area of the body2. Sometimes, tunnel-like connections can form between the lumps2. It is called sinusitis.

Signs

What is Hidradenitis Suppurativa? HS, also known as acne inversus, is a skin disorder that results in persistent inflammation. People with HS frequently develop sores in various body regions, such as the armpits, legs, or genitals. These sores may be deep-seated nodules, abscesses, draining tracts, or fibrotic scars. These sores can ooze, feel warm or hot, and have an unpleasant odor. They often develop into pus-filled bumps (abscesses) and may form scar tissue. Sometimes, these scars connect, forming channels under the skin called sinus tracts. People with HS can also have swelling of the tissues around the sores and may have limited movement because of it.

HS usually appears during puberty, though it can appear at any age. It’s most common in women, and it’s more likely for people who are Black or biracial to have it. Having family members with HS increases your risk of having it, too. It’s not clear what causes HS, but doctors think it’s a combination of genes and hormones.

A few medicines can treat HS. Antibiotics, such as lymecycline, doxycycline, or erythromycin, are given by mouth or applied to the skin to reduce inflammation and decrease the number of boils. Topical steroids, such as 1% triamcinolone cream or clobetasol propionate, can be applied to inflamed nodules to decrease pain and swelling. Retinoids, such as acitretin and isotretinoin, are vitamin-A-based medications that can help some people with HS. However, they’re not recommended for pregnant women or anyone considering becoming pregnant. Injections of biologics, such as the tumor necrosis factor inhibitors adalimumab (Humira) and infliximab (Remicade), can improve symptoms and prevent flares.

Symptoms

People with hidradenitis suppurativa develop painful nodules and pockets of infection (abscesses) in their skin. Areas of redness surround these and sometimes scarring. They often have a foul smell and can drain blood or pus when they rupture. Over time, tunnels may form under the skin, connecting the abscesses.

Although skin tags can form anywhere, they tend to develop in skin creases and folds like armpits, groin, buttocks, perineum, vulva, and scrotum. The condition is more common in women and young girls. It tends to run in families. It isn’t a sexually transmitted disease (STD) and is not caused by poor hygiene. It can be triggered by changes in sex hormones, especially during puberty and before periods. It is also more likely in people who have diabetes and in those who smoke or are overweight.

A physical exam can help diagnose hidradenitis suppurativa. A doctor might swab the inside of a nodule to check for bacteria. X-rays or ultrasound scans may help identify the extent of damage. A dermatologist can carry out a skin biopsy. There is no cure for hidradenitis suppurativa, but some treatments can help reduce symptoms and prevent complications like long-term scarring. A person with HS might benefit from joining a support group. Medications that reduce inflammation and prevent bacterial infections might help. Several types of washes might also be helpful, including those that contain chlorhexidine, zinc pyrithione, and retinol. Glucocorticoids, such as prednisone, might be prescribed, and the type 2 diabetes medication metformin may improve lesions in some people with HS.

Diagnosis

Often, the first signs of HS are small pus-filled bumps on the skin that develop and rupture over time. Eventually, the number of lumps increases, and they may form narrow channels underneath the skin, known as sinus tracts, which can also rupture.

It can be misdiagnosed for years because hidradenitis suppurativa is hard to spot. It can be mistaken for ingrown hairs, folliculitis, or acne-like rash. And because the sores are in private areas of the body, people with HS are often embarrassed to talk about them and might not seek treatment for fear of being judged.

A healthcare professional will base the diagnosis on symptoms and the skin appearance and may ask about your medical history. They might take a sample of the fluid or skin to test for bacterial infection or inflammatory markers.

Experts believe that genetics, immune dysregulation, microbes, and hormonal changes may contribute to the development of hidradenitis suppurativa, although the exact cause is unknown. Furthermore, consuming dairy, red meat, and high glycemic index foods can exacerbate symptoms. Fortunately, having a treatment plan in place can help in managing the disease. Reduce pain and prevent future recurrence. It may include avoiding certain foods, using antibiotic creams to treat bacterial infections, and avoiding stress, which can worsen symptoms. In addition, a health care provider might recommend gentle skin care, pain medicine, and bleach baths or may refer you to a dermatologist a specialist in the treatment of skin conditions.

Treatment

A variety of treatments can control symptoms and prevent complications. Talk to your healthcare team about a plan that’s right for you.

Skin doctors (dermatologists) can diagnose the cause of your nodules and prescribe medications to reduce them, including antibiotics, steroids, hormone modulators, and retinoids. They may also recommend an over-the-counter or prescription pain reliever and refer you to a pain management specialist.

If you’re a woman, gynecologists can screen for polycystic ovary syndrome and treat hormonal imbalances that may worsen your HS. Gynecologists can also prescribe birth control pills to ease premenstrual flare-ups.

Doctors specializing in infections may prescribe antimicrobial washes containing chlorhexidine or benzoyl peroxide to clean the area. They may also recommend a low dose of the diabetes medication metformin to help regulate your insulin levels and lower fluid retention. Hormone regulators, such as spironolactone or clomiphene citrate, may be used off-label to reduce bloating from hormone fluctuations and the risk of premenstrual flare-ups.

In some severe cases, a healthcare provider may suggest removing the inflamed tissue through incision and drainage. It is usually done in the hospital and is meant to be a short-term solution. A more permanent option is to remove the tunnels that connect inflamed nodules with your skin, a procedure called unroofing. It can be done in the office with a punch device or by making a wide surgical excision under general anesthesia.