Hidradenitis Suppurativa

What is hidradenitis suppurativa (HS)?

Hidradenitis suppurativa (HS) is an autoinflammatory condition. It is sometimes called acne inversa. Hidradenitis suppurativa attacks your hair follicles, causing recurring, painful abscesses or boils. These boils occur in parts of the body that have sweat glands.

There is no cure for hidradenitis suppurativa, but treatments are available which can manage and relieve the symptoms and stop new boils and scarring.

Hidradenitis suppurativa can cause different types of skin growths, including:

• Abscesses: Pockets of pus which smell bad when drained.
• Nodules: Firm lumps under the skin’s surface.
• Sinus tracts: These are channels between the abscesses and the skin’s surface.

Who is affected by hidradenitis suppurativa?

Women are more likely to have hidradenitis suppurativa than men.

Those with the following risk factors are also more likely to develop the condition:

• Hirsutism (excessive hair growth)
• Family history of hidradenitis suppurativa
• Fluctuating sex hormone levels (seen in those going through puberty or just before menopause)
• Smoking
• Obesity

Hidradenitis suppurativa is not a contagious condition and it is not the result of poor hygiene.

What causes hidradenitis suppurativa?

In people with hidradenitis suppurativa, the body attacks your hair follicles (an autoinflammatory disease). This results in chronic inflammation, abscesses, and scarring.

What are the symptoms of hidradenitis suppurativa?

Hidradenitis suppurativa causes painful abscesses which drain pus. Over time, they leave scars. Women experience a flare up of symptoms just before their period.

The boils form in the following area:

• Crease under the breasts
• Anus
• Buttocks
• Genitals
• Armpits
• Nape of the neck
• Groin
• Inner thighs
• Waist

If hidradenitis suppurativa is left untreated, it can increase the risk of other conditions developing, including:

• Cellulitis
• Anemia
• Scars
• Sepsis
• Lymphatic system damage
• Fistula

It can also cause skin cancer, but this is very rare.

How is hidradenitis suppurativa diagnosed?

It is important to see a specially trained dermatologist who will recognize the symptoms of hidradenitis suppurativa, as the condition is often misdiagnosed as infection-related boils.

A dermatologist will ask you about your medical history and perform a physical examination.

How is hidradenitis suppurativa treated?

Treatment for hidradenitis suppurativa will depend on its severity and your symptoms.

Hidradenitis suppurativa may initially be treated with:

A skin care plan

Your dermatologist will recommend things such as skin care products that are gentle on skin and may suggest using an antiseptic wash daily. They may recommend a retinoid which can reduce inflammation.

Pain management

Several things can help to relieve the pain associated with hidradenitis suppurativa, such as applying a cold or warm compress, pain medications or a lidocaine ointment.

Medications

Some people with hidradenitis suppurativa will be offered medications, including:

• Antibiotics: These fight the inflammation which is driving the condition.
• Biologic therapy: These can reduce inflammation by suppressing the immune system response.
• Metformin: A medication given to diabetics, it can stabilize hormone levels and decrease insulin resistance.
• Oral contraceptives: Can regulate hormone levels.

Procedures and surgery

People with advanced hidradenitis suppurativa, that causes severe symptoms that aren’t responding to the above therapies, may require a procedure. These include:

• An incision in the abscess to drain them.
• Botox: The toxin can control excessive sweating.
• Deroofing: This is a surgery that removes skin which is covering sinus tracts.
• Laser hair removal
• Laser surgery: To remove boils.
• Steroid injections can reduce inflammation.

Surgery may be considered for people with persistent or severe symptoms of hidradenitis suppurativa. Surgery involves removing the full thickness of affected skin. A skin graft may be required following surgery to close the wound.

Surgery can lead to lymphedema of the upper limbs due to damage to the lymphatic channels. A procedure called reverse axillary mapping (RAM) during surgery to remove axillary hidradenitis suppurativa (found in the armpit areas, where lymph nodes are located) can reduce the incidence of lymphedema.

Life with hidradenitis suppurativa

There are many different treatments available that can help people living with hidradenitis suppurativa, including novel treatments that can address the side effects of both the condition and the procedures to treat it.