Hidradenitis Suppurativa

Definition

Hidradenitis suppurativa (HS) is an inflammatory condition of the hair follicle. Inflamed nodules and cysts form in the armpits and groin. These may also be found under the breasts, and around the nipples and anus. Less commonly other areas of the body can be affected.

Sweat Gland

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Causes

The hair follicle becomes blocked causing inflammation. The blockage may lead to absesses, infection, or scarring. The sweat glands may also become inflamed.

Menstruation in women, weight gain, stress, hormonal changes, heat, and excessive perspiration may trigger the condition.

Risk Factors

HS is more common in women than in men. Other factors that increase your chance of HS include:

• Family history
• Current or history of smoking
• Obesity
• Diabetes
• Metabolic syndrome—a condition marked by elevated blood pressure, cholesterol, blood glucose, and body weight
• Lipid disorders, including low HDL (good) cholesterol levels and/or high triglycerides

Symptoms

HS usually presents at puberty, but may occur at any age after that. It may cause:

• Burning, itching, or painful lumps in the armpits, groin, under the breasts, around the nipples or anus, and other involved areas
• Pus leaking from openings in the lumps
• Scarring

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. In most cases, the doctor will be able to make a diagnosis by looking at the abscesses and nodules.

Sometimes cultures will be done of the drainage. Occasionally, other blood tests or an ultrasound of the lesions is done.

Treatment

The treatment will depend on the stage of the disease. Talk with your doctor about the best treatment plan for you. Options may include one or more of the following:

Home Care and Lifestyle Changes

You may be able to improve the condition by taking these steps:

• Use warm compresses to relieve discomfort and promote abscess drainage.
• Avoid shaving if your skin becomes irritated.
• Wear loose-fitting, non-synthetic clothing.
• Use antibacterial soap.
• Try to avoid heat and humidity.

If you smoke, talk to your doctor about finding a program to help you quit. It is also important to maintain a healthy weight and eat a healthful diet. If you need help losing weight, consider talking to a dietitian who can help you with meal planning.

Medications

Your doctor may prescribe 1 or more medications depending on the severity of your HS.

Antibiotics

Your doctor may recommend oral or topical antibiotics.

Corticosteroids and Other Immunosuppresants

Corticosteroids may help improve symptoms. These can be taken by mouth, applied to the skin, or injected into the area.

Other medications called biologics, which decrease the body's immune response, may be used in severe cases. These medications have many risks, so your doctor will carefully weigh the risks and benefits of using these.

Other Medications

Hormonal medications, such as oral contraceptives can be used in some cases. At other times, medications called retinoids may be used.

Surgery

Small lesions can be treated in the doctor's office. The sores may be cut open and allowed to drain. If your condition is severe, then a wide area may need to be removed. In these cases, a skin graft may be needed.

Other procedure options include:

• Laser surgery—uses lasers to remove lesions
• Cryosurgery—uses cold to freeze lesions
• Laser hair removal

Prevention

There are no current guidelines to prevent HS.