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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 multiplying inside the hair follicle. The follicles then burst spilling keratin and bacteria, into the surrounding hair follicles and skin. This provokes an inflammatory response and the skin becomes inflamed. This stage presents as a deep painful pimple (nodule) or painful and swollen lump filled with pus (abscess). In severe cases, pus-filled channels called sinus tracts form under the skin. The inflamed skin heals by scarring. Over the years, repeated flare-ups will produce thick bands of scars that might limit your movements.

Key factors that can worsen a pre-existing Hidradenitis suppurativa include:

  • Pressure or rubbing on the skin,

  • Friction between skin folds

  • Increased sweat production and retention

  • Triggers such as menstruation, weight gain, stress, hormonal changes, excessive heat and sweating.

The disease appears to have both hereditary and environmental influences. It 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. Bacteria do not appear to be a causative agent in this condition.

It is important to understand that Hidradenitis suppurativa is

  • NOT caused by lack of or poor personal hygiene

  • NOT contagious and does not spread from person to person via direct or indirect contact

Symptoms of hidradenitis suppurativa

This skin disease causes 1 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. It may be mistaken for other skin conditions. The painful bumps also often return. So, treating existing bumps, minimizing pain and drainage, preventing disease progression, stopping new bumps, decreasing the frequency of recurrence, 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 stay away from 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 or oral retinoid. These may cause side effects. Anti-androgenic hormonal therapy can also be helpful in a few selected cases.

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

  • Surgery. Surgery can drain and remove the painful bumps. For severe cases, the healthcare provider may cut out the entire area of affected skin that has bumps, tracts, and scars. Other options include using localized laser and pulsed light therapy, which help to disrupt the inflammatory process.

  • Management of underlying conditions that contribute to the development of or worsening of Hidradenitis suppurativa.

  • Self-care: The following suggestions of self-care at home might prove helpful in managing your illness.

    • Avoiding skin trauma.

    • Not wearing tight and synthetic clothing

    • Avoiding harsh skincare products or cleaning tools (loofahs, washcloths, brushes)

    • Avoiding adhesive dressings

    • Using soft dressings with clear petroleum jelly or non-occlusive dressings to prevent irritating bumps or abscesses.

Possible complications of hidradenitis suppurativa

These include:

  • Limb contractures, Arthritis, and impaired mobility

  • Psychosocial distress due to drainage, odor, and location of lesions. It includes Depression, social isolation, decreased relationship satisfaction, sexual dysfunction, and reduced work productivity.

  • Lymphedema

  • Scarring of skin

  • Long-term effects of chronic inflammation such as anemia, hyperproteinemia, and amyloidosis.

  • Skin cancer

When to call your healthcare provider

Call your healthcare provider right away if you have any of these:

  • Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider

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

  • Pain that gets worse

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

  • New symptoms

Date Last Reviewed: 5/1/2022
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