What is hidradenitis suppurativa?

Hidradenitis suppurativa (HS) is a chronic skin disease. It causes deep, painful boils or pockets of infection (abscesses) in your skin. These abscesses grow when the deep roots of hair follicles get blocked. A hair follicle is the base (root) of a hair.

HS commonly occurs in areas where skin rubs together, such as armpits and in the groin and anal areas. But they may also be found elsewhere, such as the neck or scalp. When these glands become blocked, they fill with fluid and can become infected. They then burst, and the infection spreads. This causes larger areas of swelling, infection, and abscesses that can spread through the layers of skin.

Hidradenitis suppurativa is also known as acne inversa. But it is not a form of acne. It is also not contagious. It is an ongoing health problem that flares up, goes away for a while, and then comes back. In women, symptoms may get worse before a menstrual period and then go away after. Over time, you may find that the flare-ups don’t go away, and your skin can become scarred. Early treatment is important to prevent HS from getting worse.

What causes hidradenitis suppurativa?

Experts aren’t exactly sure what causes hidradenitis suppurativa. It seems to develop when hair follicles get blocked and rupture. Then the area becomes inflamed. But it most often develops after puberty. It tends to affect young adults while they are growing. Hormones may be involved.

Who is at risk for hidradenitis suppurativa?

The risk factors for this skin disease are:

• Being female

• Having a family history of it

• Smoking

• Being overweight

What are the symptoms of hidradenitis suppurativa?

The symptoms of this skin disease are:

• Painful boils in areas of skin that have hair and are near the sweat glands, such as under your arms or around the groin

• Painful, swollen lumps under the skin

• Pus-filled, oozing boils

• Bad odor from the boils

• Changes in skin color and scarring around the area

How is hidradenitis suppurativa diagnosed?

Your healthcare provider will ask about your health history and do a physical exam. They will note the number and location of sores and inflamed areas on your body. You may also need these tests:

• Blood test

• Culture test of the fluid from the lesions

How is hidradenitis suppurativa treated? 

Treatment for this skin disease may include:

• Antibiotics. Many people find some relief by using antibiotics, either spread on the skin (topical) or taken by mouth.

• Lose weight, if needed. It may help ease your symptoms.

• Other medicines for flare-ups. These include immune-suppressing medicines, tumor necrosis factor-targeting medicines, retinoids, and anti-androgen therapy.

• Steroid shots. They are done directly into sores to reduce inflammation.

• Surgery. If other treatments don’t work, your healthcare provider may advise removing the sores through surgery or with a laser. After, you may need reconstructive surgery. This may include skin grafting and flaps to fix the affected skin.

What are possible complications of hidradenitis suppurativa?

Complications can include:

• Pain and discomfort

• Infection

• Social isolation and embarrassment

• Scarring

• Squamous cell skin cancer (rare)

How do I manage hidradenitis suppurativa?

This disease can be hard to live with. It tends to affect young people at a time when many are very sensitive about how they look. It is painful. The appearance and even the smell of the affected skin may also make you not want to be around friends and family or do activities, such as group sports. Preventing this kind of isolation is one of the main reasons to get treatment.

You may not be able to prevent hidradenitis suppurativa because the cause isn’t fully understood. But you can take steps to lower your risk of a flare-up:

• Lose weight or maintain a healthy weight.

• Don’t smoke.

• Stay out of hot, humid climates.

• Try to keep a low stress level,

• Seek counseling if you feel isolated and depressed.

• Don't wear tight, synthetic clothing.

• Take good care of your skin and maintain correct hygiene.

• Don’t cut the sores. It can lead to chronic scarring and more complicated cysts.

• Follow your healthcare provider’s advice on medicine, surgical choices, and care of your skin after treatment.

• Keep all follow-up appointments

When should I call my healthcare provider?

Schedule an office visit if pain and infection occur. Don't put off a visit to your healthcare provider because you are embarrassed by the symptoms or location of this disease. Dermatologists are familiar with this disease and how and where it shows up. It's critical to get treatment early. This can help reduce scarring and more severe problems later in life.

Key points about hidradenitis suppurativa

• Hidradenitis suppurativa is a chronic skin disease. It causes deep, painful boils or pockets of infection (abscesses) in your skin.

• It is not contagious.

• Ongoing flare-ups may cause scarring of the skin.

• Being female and having a family history of the disease raises your risk for it.

• A physical exam can help diagnose it.

• Treatment may include certain medicines, such as antibiotics, and surgery.

• Feelings of isolation and depression are common with this disease. Counseling can help.

• Not smoking and losing weight, if needed, may help lower the risk for flare-ups.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new directions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions.