Understanding Hidradenitis Suppurativa

Hidradenitis suppurativa is a long-term (chronic) inflammatory skin disease. It causes painful bumps and sores (abscesses) to form around a hair follicle. Follicles are the tiny holes from which hair grows out of your skin. The disease occurs on parts of the body where skin rubs together. It most often appears in the armpits, inner thighs, the groin area, and under the breasts. It's more common in women.

 How to say it

HI-drah-duh-NI-tihs SUHP-er-uh-TEE-vuh

What causes hidradenitis suppurativa?

This skin disease happens when hair follicles become clogged with keratin. Keratin is the protein that makes up your hair and nails. As keratin and sweat build up, the bacteria start to multiply inside the hair follicle. The follicles then burst, spilling keratin and bacteria into the surrounding hair follicles and skin. This sets off an inflammatory response, and the skin becomes inflamed.

The disease tends to run in families. It’s also more likely to occur in people who are obese, have diabetes, or smoke. Hormones or the immune system may also play a part.

Symptoms of hidradenitis suppurativa

This skin disease causes one or more painful red bumps on the skin. These bumps become inflamed and drain pus. They may also itch or burn. In severe cases, sinus tracts may form. These are narrow pus-filled channels that run under the skin. Blood or a bad-smelling pus may ooze from these bumps or sinus tracts. Bands of scarring often occur.

Treatment for hidradenitis suppurativa

Treatment for this skin disease is most successful when started early. But it may be hard to diagnose because it may be mistaken for other skin conditions. The painful bumps also often return. So treating existing bumps, stopping new bumps, and limiting scarring is important. Treatment choices include:

• Warm compress. Putting a warm, wet washcloth on the affected skin may help.

• Lifestyle changes. Your symptoms may get better if you lose weight or stop smoking, if needed. Also avoid shaving or other irritants, such as deodorant or perfume.

• Antibiotics. For mild cases, an antibiotic applied to the skin (topical) may help. You may need oral antibiotics if you have a severe case. They can help prevent further infection.

• Other oral medicines. Over-the-counter pain medicines can ease pain and inflammation. You may need stronger medicines for a severe case. These medicines include corticosteroids and oral retinoids. These may cause side effects. Anti-androgenic hormonal therapy can also be helpful in a few cases.

• Injected medicines. A steroid may be injected into the bump to ease pain. A newer biologic medicine is given by I.V. It may be used for severe symptoms.

• Surgery. Surgery can drain and remove the painful bumps. For severe cases, the doctor may cut out the entire area of affected skin that has bumps, tracts, and scars. Other choices include using localized laser and pulsed light therapy, which helps with inflammation.

Possible complications of hidradenitis suppurativa

These include:

• Limb contractures, arthritis, and impaired mobility.

• Depression.

• Lymphedema.

• Scarring of skin.

• Skin cancer.

When to call your doctor

Contact your doctor or get medical care right away if you have:

• A fever of 100.4°F (38°C) or higher, or as directed by your doctor.

• Redness, swelling, or fluid leaking from your rash that gets worse.

• Pain that gets worse.

• Symptoms that don’t get better or that get worse.

• New symptoms.