What is hidradenitis suppurativa?
Hidradenitis suppurativa (HS) is a long-term skin condition that results in red lumps and boils developing in areas such as the armpits, groin, under the breasts, the lower abdomen and buttocks. The lumps are painful; they may discharge; and they may cause scarring.
What hidradenitis suppurativa is NOT
Hidradenitis suppurativa is NOT contagious. It is NOT due to an infection. It is NOT due to poor hygiene.
Who gets hidradenitis suppurativa?
HS typically begins after puberty and is more common in women. Family history, smoking, obesity, and certain hormonal influences may be relevant factors in some cases.
What causes hidradenitis suppurativa?
HS is due to inflammation in the skin. What this means is that there is a small part of the immune system coming into the skin causing painful “inflamed” bumps – but the immune system should not be there – we simply do not know why it is there. Although HS is a different condition to acne, we all know that acne can look like infection (with pustules and sometimes boil-like bumps) but yet, like HS, acne is not an infection. Although HS is not infectious, one theory suggests that the immune system is inappropriately trying to get rid of some of the harmless bacteria that live in the hair follicles.
What are the clinical features of hidradenitis suppurativa?
- Boils in certain areas, including the skin folds, which may come and go
- Recurrent large abscesses
- Discharge of pus through holes in the skin (sinuses)
- Scarring and changes to skin texture over time
How is hidradenitis suppurativa treated?
General Measures
- Maintain a healthy weight
- Stop smoking
Medical Treatments
Treatments are aimed at reducing inflammation in the skin. Even though antibiotics may be prescribed, they are used here, not just to reduce some of the bacteria that the immune system may be reacting against, but also because some antibiotics can themselves calm down parts of the immune system. This is the same reason why antibiotics may be used to treat acne.
- Topical antibiotics or antiseptics
- Steroid (cortisone) injections into the boils
- Oral antibiotics
- Hormonal therapy
- “Biologics” (ie. injections that dampen down a small targeted part of the immune system)
- Surgical treatment
What is the outcome of hidradenitis suppurativa?
HS is a chronic condition with flares and remissions. While it can be challenging to manage, early diagnosis and specialist treatment can significantly improve outcomes.