What is Hidradenitis Suppurativa

Hidradenitis suppurativa is a long-term (chronic) skin disease. It is similar to a severe form of acne, but it affects areas of the body where acne would be unusual, especially areas of the body where skin rubs against skin and becomes moist. These include:

• Underarms.
• Groin.
• Genital area.
• Buttocks.
• Upper thighs.
• Breasts.

Hidradenitis suppurativa may start out as small lumps or pimples caused by blocked sweat glands or hair follicles. Pimples may develop into deep sores that break open (rupture) and drain pus. Over time, affected areas of skin may thicken and become scarred. This condition is rare and does not spread from person to person (non-contagious).

What are the causes?

The exact cause of this condition is not known. It may be related to:

• Male and female hormones.
• An overactive disease-fighting system (immune system). The immune system may over-react to blocked hair follicles or sweat glands and cause swelling and pus-filled sores.

What increases the risk?

You are more likely to develop this condition if you:

• Are female.
• Are 11–55 years old.
• Have a family history of hidradenitis suppurativa.
• Have a personal history of acne.
• Are overweight.
• Smoke.
• Take the medicine lithium.

What are the signs or symptoms?

The first symptoms are usually painful bumps in the skin, similar to pimples. The condition may get worse over time (progress), or it may only cause mild symptoms. If the disease progresses, symptoms may include:

• Skin bumps getting bigger and growing deeper into the skin.
• Bumps rupturing and draining pus.
• Itchy, infected skin.
• Skin getting thicker and scarred.
• Tunnels under the skin (fistulas) where pus drains from a bump.
• Pain during daily activities, such as pain during walking if your groin area is affected.
• Emotional problems, such as stress or depression. This condition may affect your appearance and your ability or willingness to wear certain clothes or do certain activities.

How is this diagnosed?

This condition is diagnosed by a health care provider who specializes in skin diseases (dermatologist). You may be diagnosed based on:

• Your symptoms and medical history.
• A physical exam.
• Testing a pus sample for infection.
• Blood tests.

How is this treated?

Your treatment will depend on how severe your symptoms are. The same treatment will not work for everybody with this condition. You may need to try several treatments to find what works best for you. Treatment may include:

• Cleaning and bandaging (dressing) your wounds as needed.
• Lifestyle changes, such as new skin care routines.
• Taking medicines, such as:
  • Antibiotics.
  • Acne medicines.
  • Medicines to reduce the activity of the immune system.
  • A diabetes medicine (metformin).
  • Birth control pills, for women.
  • Steroids to reduce swelling and pain.
• Working with a mental health care provider, if you experience emotional distress due to this condition.

If you have severe symptoms that do not get better with medicine, you may need surgery. Surgery may involve:

• Using a laser to clear the skin and remove hair follicles.
• Opening and draining deep sores.
• Removing the areas of skin that are diseased and scarred.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if your condition improves.

Skin care

• If you have open wounds, cover them with a clean dressing as told by your health care provider. Keep wounds clean by washing them gently with soap and water when you bathe.
• Do not shave the areas where you get hidradenitis suppurativa.
• Do not wear deodorant.
• Wear loose-fitting clothes.
• Try to avoid getting overheated or sweaty. If you get sweaty or wet, change into clean, dry clothes as soon as you can.
• To help relieve pain and itchiness, cover sore areas with a warm, clean washcloth (warm compress) for 5–10 minutes as often as needed.
• If told by your health care provider, take a bleach bath twice a week:
  • Fill your bathtub halfway with water.
  • Pour in ½ cup of unscented household bleach.
  • Soak in the tub for 5–10 minutes.
  • Only soak from the neck down. Avoid water on your face and hair.
  • Shower to rinse off the bleach from your skin.

General instructions

• Learn as much as you can about your disease so that you have an active role in your treatment. Work closely with your health care provider to find treatments that work for you.
• If you are overweight, work with your health care provider to lose weight as recommended.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• If you struggle with living with this condition, talk with your health care provider or work with a mental health care provider as recommended.
• Keep all follow-up visits as told by your health care provider. This is important.

Where to find more information

• Hidradenitis Suppurativa Foundation, Inc.: https://www.hs-foundation.org/  

Contact a health care provider if you have:

• A flare-up of hidradenitis suppurativa.
• A fever or chills.
• Trouble controlling your symptoms at home.
• Trouble doing your daily activities because of your symptoms.
• Trouble dealing with emotional problems related to your condition.

Summary

• Hidradenitis suppurativa is a long-term (chronic) skin disease. It is similar to a severe form of acne, but it affects areas of the body where acne would be unusual.
• The first symptoms are usually painful bumps in the skin, similar to pimples. The condition may get worse over time (progress), or it may only cause mild symptoms.
• If you have open wounds, cover them with a clean dressing as told by your health care provider. Keep wounds clean by washing them gently with soap and water when you bathe.
• Besides skin care, treatment may include medicines, laser treatment, and surgery.