Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a condition that causes painful bumps under your skin in the hair roots near some of your sweat glands. It’s also known as acne inversa.

Causes of Hidradenitis Suppurativa #

• Doctors aren’t sure what causes hidradenitis suppurativa, but it’s probably tied to your genes and to things in the world around you.

• It’s more common in women than in men.

• It’s also more likely if you’re overweight, if you smoke, and if you’ve had acne. About a third of people who get HS have a relative with it.

• The skin problems start when hair follicles get blocked.

• You often get the first symptoms in your teens or 20s.

• You don’t get HS because you don’t wash enough, because you use deodorants or powders, or because you shave your underarms.

• You also can’t catch it from someone else or give it to another person.

Stages of Hidradenitis Suppurativa #

Hurley stage I #

A single bump with no sinus tracts

Hurley stage II #

More than one bump but little tunneling

Hurley stage III #

Multiple bumps with a lot of sinus tracts and scars, involving an entire area of your body

Symptoms of Hidradenitis Suppurativa #

• HS usually affects both sides of your body. You can get the bumps in one place or in several areas at once.

• The first warning sign might be a single painful bump that gets inflamed.

• It can last days or months. You could have repeated outbreaks of a single bump in the same location or the same general area.

• Besides turning into pockets of pus, the bumps can be itchy. Your skin might have small pitted areas with blackheads.

• Some people get tunnels under their skin, called sinus tracts, which connect different areas of HS outbreaks.

• The bumps and leaky pockets can go away and come back. In severe cases, they don’t fully heal.

Diagnosis of Hidradenitis Suppurativa #

Your doctor will check your skin and make a diagnosis based on where the bumps and pockets are and how often you have them.

They may also ask you things like:

• How long ago did your symptoms begin?

• Are they painful?

• Have you had these symptoms before?

• Have any close relatives had this problem?

• You probably won’t have tests unless your doctor needs to rule out other kinds of infections. Then, they’ll take a sample of pus and send it to a lab for testing.

Treatment of Hidradenitis Suppurativa #

Warm compresses #

You might try this first if your case is mild. Run a clean washcloth under hot water and hold it on your skin for 10 minutes.

NSAIDs(nonsteroidal anti-inflammatory drugs) #

These over-the-counter medicines can ease your pain and help manage swelling. They include:

• Aspirin

• Ibuprofen

• Naproxen

Antibiotics #

• These medications fight infections. You can swallow them as a pill, or you can use a cream, ointment, cleanser, wash, or gel on your skin.

• At first, you may use doxycycline or minocycline for 2 to 3 months.

• If that doesn’t help, your doctor may suggest a combination of clindamycin and rifampin (Rifadin, Rimactane).

Corticosteroids #

Your doctor injects these medicines into the bumps. They can ease inflammation, pain, and swelling. You usually get these shots once a month for up to 3 months. If your case is severe, your doctor may recommend that you take steroid pills by mouth.

Oral retinoids #

Your doctor may suggest a retinoid medication in a pill, such as acitretin (Soriatane) or isotretinoin (Accutane). Both can improve severe cases of HS.

Topical resorcinol #

This is a cream that you put on inflamed areas of your skin. It has chemicals that peel the skin.

Hormone therapy #

Some women find that their condition gets better if they take birth control pills or a drug called spironolactone.

Biologics #

These medications work on your immune system, your body’s defense system against germs. You take them by getting a shot, either at the doctor’s office or at home. Or you may need to get the meds through an IV in your veins. This is done at a clinic or hospital.

Surgery #

• If your bumps grow deep into your skin, you might have a surgical procedure.

• If you’re having problems in a small area, your doctor can cut open pockets to drain pus. This gives you short-term relief.

• In a procedure called deroofing, your doctor turns deep, painful bumps and pockets into scars that won’t hurt.

• It’s an option if you have painful bumps that come back over and over.

• Another type of surgery involves cutting out skin in the problem spots.

• Afterward, your doctor will do a skin graft.

• They take skin from another part of your body and use it to cover the area where you had the operation.

• Laser surgery is another option to clear new, deep bumps.

• It destroys hair follicles, the shafts in your skin where hair grows. You may need several treatments.