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
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:
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).
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.
Your doctor may suggest a retinoid medication in a pill, such as acitretin (Soriatane) or isotretinoin (Accutane). Both can improve severe cases of HS.
This is a cream that you put on inflamed areas of your skin. It has chemicals that peel the skin.
Some women find that their condition gets better if they take birth control pills or a drug called spironolactone.
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.
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.