Hidradenitis Suppurativa

What is hidradenitis suppurativa (HS)?

Hidradenitis suppurativa (HS) is a chronic skin disease. Another name for it is acne inversa. It causes painful, boil-like lumps that form under the skin. It often affects areas where the skin rubs together, such as your armpits and groin. The lumps become inflamed and painful. They often break open, causing abscesses that drain fluid and pus. As the abscesses heal, they can cause scarring of the skin.

What causes hidradenitis suppurativa (HS)?

The lumps in HS form because of blockages of the hair follicles. The blocked hair follicles trap bacteria, which leads to inflammation and rupture. In most cases, the cause of the blockages is unknown. Genetics, environment, and hormonal factors may play a role.

HS is not caused by bad hygiene, and it cannot be spread to others.

Who is more likely to get hidradenitis suppurativa (HS)?

HS typically starts after puberty, usually in the teens or twenties. It is more common in:

• Women
• People who are Black
• People with a family history of HS
• People who are overweight or have obesity
• People who smoke

What are the symptoms of hidradenitis suppurativa (HS)?

The symptoms of HS include:

• Small pitted areas of skin containing blackheads.
• Painful, red, lumps that get bigger and break open. This causes abscesses that drain fluid and pus. They may itch and have an unpleasant odor.
• The abscesses heal very slowly, come back over time, and can lead to scarring and tunnels under the skin.

Symptoms of HS can range from mild to severe. They can include:

• Only one or a few lumps in one area of the skin.
• Lumps that keep coming back, get bigger, and break open. The lumps form in more than one area of the body.
• Lumps that are widespread, along with scarring, and chronic (long-term) pain that may make it hard to move.

Because of the difficulty of dealing with the disease, people with HS are at risk for depression and anxiety.

How is hidradenitis suppurativa (HS) diagnosed?

There is no specific test for HS. It can be hard to diagnose in the early stages because it can look like pimples or acne. To find out if you have HS, your health care provider:

• Will ask about your medical history and your symptoms
• Will look at the lumps on your skin
• May take a sample of the skin or pus (if there is any) and send it to a lab for testing

Your provider may refer you to a dermatologist (a doctor who specializes in skin disorders) to get a diagnosis or treatment.

What are the treatments for hidradenitis suppurativa?

Treatments focus on the symptoms, but they are not always effective for everyone. The treatments depend on how severe the disease is and may include:

• Medicines, including steroids, antibiotics, pain relievers, hormone pills, and medicines that fight inflammation. In mild cases, the medicines may be topical (applied to your skin), injected or taken orally (by mouth).
• Biologics, which are a type of medicine made from living sources, such as cells, tissues, and proteins.
• Procedures or surgery to remove the lumps and scars or make the sores go away.
• Laser hair removal may be helpful in the early stages of HS.

It may also help if you can avoid things that can irritate your skin, by:

• Wearing loose-fitting clothing
• Staying at a healthy weight
• Quitting smoking
• Avoiding heat and humidity
• Being careful not to injure your skin

Questions for your care team

General prompts to help prepare for your appointment.

• How does this information apply to my situation?
• Which symptoms or results need evaluation?
• Which tests are useful, and what can they tell us?
• What care options, benefits, and risks should we discuss?
• When should I seek urgent help, and whom should I call?
• When is follow-up, and how will we know whether the plan is working?