Hidradenitis suppurativa (HS) is a chronic skin disease, similar to acne, that affects hair follicles in places where the skin is folded or rubs up against other skin. The most common areas of the body affected by HS include the armpits and breast folds, but HS can also appear on the inner thighs, groin, mid-waist, nipples, between the buttocks, the area around the anus, or between the anus and genitals. HS can be easily mistaken for acne—its other medical name is “acne inversa.” The earliest symptoms are blackheads, small red bumps, or cysts. Unlike acne, these lesions can be tender or painful. Their appearance is often preceded by itching, burning, pain, or excessive sweating in the area for a few days. At more advanced stages, abscesses form. The drainage from these abscesses can smell very bad. Tunnels called sinus tracts form beneath the skin. Eventually, the entire area might be covered in abscesses and nodules, and the pain can be unbearable. The lesions leave permanent scars, often violet in color, but sometimes bumpy and fibrotic.
Hidradenitis suppurativa is a common health condition that can affect anyone, regardless of age, sex, race, or ethnicity.
Early signs of hidradenitis suppurativa include burning, itching, discomfort, reddening, or excessive sweating on an area of skin in the armpits, breast folds, groin, inner thigh, or around the anus. These early symptoms are quickly followed by the formation of blackheads or red bumps that are tender to the touch.
Serious symptoms of hidradenitis suppurativa, such as severe pain, may require immediate medical attention.
Hidradenitis suppurativa is caused by a blockage of hair follicles and subsequent inflammation due to genetic and environmental factors. You may be at risk for developing hidradenitis suppurativa symptoms if you have a family history of HS, are female, or are Black. Other risk factors include smoking, excess weight, obesity, diabetes, tight clothes, shaving, and excessive deodorant use.
Hidradenitis suppurativa usually requires a medical diagnosis.
Hidradenitis suppurativa generally requires treatment. Symptoms typically improve with treatment, but it is a chronic condition with repeated flare-ups.
Treatment of hidradenitis suppurativa may include topical antibiotics, oral antibiotics, hormone treatments, retinoids, steroid injections, immunosuppressants, pain relievers, surgery, and lifestyle changes.
Untreated hidradenitis suppurativa could result in complications, such as scars, lymphedema, infection, anemia, cancer, arthritis, anal fistula, depression, and social isolation.
Use coupons for hidradenitis suppurativa treatments, such as Cleocin-T (clindamycin phosphate), Vibramycin (doxycycline), Soriatane (acitretin), Claravis (isotretinoin), and Humira (adalimumab), to save up to 80%.
The early signs of hidradenitis suppurativa can be discomfort, itching, burning, stinging, pain, or excessive sweating on an area of skin within a skin fold, usually the armpits or under the breasts. Other affected body areas might include the nipples, groin, anal area, perineum, inner thighs, or between the buttocks. These earliest symptoms occur in half or more people. These symptoms are followed by the formation of a solitary blackhead or pimple (papule) that may be tender to the touch.
Hidradenitis suppurativa is usually a progressive and chronic condition that may spontaneously remit, often for years. As the condition worsens, symptoms will change.
Early symptoms of hidradenitis suppurativa (Hurley Stage I HS) include:
Discomfort
Itching
Excessive sweating
Solitary, tender papules, nodules, or cysts (swollen, red bumps on the skin)
Abscesses
As the condition worsens (Hurley Stage II HS), typical symptoms include:
Multiple nodules and cysts that keep recurring
Pain
Abscesses
Bad-smelling discharge from abscesses
Sinus tracts (tunnels beneath the skin that connect abscesses or nodules)
Scarring
In the most severe cases (Hurley Stage III HS), symptoms include:
Abscesses and nodules throughout the affected area
Multiple sinus tracts connecting abscesses
Extensive scarring
Scars typically appear as violet areas or raised scars. Sinus tracts can leave plaques or crisscrossing, raised scars that look like a net or web. Scars can be severe enough to compromise people’s ability to move certain muscles, like lifting their arms or moving their legs.
Unfortunately, it takes a long time for people to get diagnosed with HS—typically seven years. HS is easily misdiagnosed as other conditions, including acne, boils, folliculitis, ingrown hairs, bacterial infections, or genital herpes. If HS breaks out around the genitals or anus, it could be mistaken for genital herpes. Some of the early symptoms of HS are the same as those of a genital herpes outbreak, but there are differences. Herpes is more likely to directly affect the genitals, though HS can also cause lesions on the scrotum and vulva. More importantly, a genital herpes flare-up lasts about two or three weeks, then resolves. HS is chronic and worsens over time without treatment.
Hidradenitis suppurativa | Herpes | |
Shared symptoms |
|
|
Unique symptoms |
|
|
RELATED: Herpes treatments and medications
See a healthcare provider if you notice a tender nodule or abscess in a place where one usually doesn’t appear, such as the armpits or underneath a breast. If there are multiple painful nodules or abscesses in a skinfold area, do not hesitate to see a clinician. Go to an emergency room if the pain is severe.
Hidradenitis may initially be diagnosed by a primary care provider, but the final diagnosis may be made by a dermatologist. A dermatologist will diagnose HS based on the visual appearance of the lesions and medical history. Testing, biopsy, and imaging are rarely needed unless there’s some uncertainty.
RELATED: When to see a dermatologist
Untreated complications of hidradenitis suppurativa include:
Scarring
Limited limb movement
Impaired ability to move around or walk
Infection
Lymphedema
A type of skin cancer called squamous cell carcinoma
Increased risk of other cancers
Amyloidosis, is a protein build-up in vital organs like the heart or kidneys
Rectal or urethral fistulas, small tunnels from the skin to the anus, bowel, or urethra
Psychosocial problems, such as reduced quality of life, depression, anxiety, social withdrawal, and an increased risk of suicide
Once hidradenitis suppurativa has been diagnosed, either a family physician or a dermatologist will treat the disease, depending on the severity. Treatment pursues four goals:
Treating lesions
Reducing pain
Preventing recurrence
Preventing any worsening of the disease
Mild cases of hidradenitis suppurativa are treated with:
Topical antiseptics
Surgical removal of bumps (punch debridement)
Incision and drainage of abscesses
Corticosteroid injections into the lesions
Moderate cases of hidradenitis suppurativa are treated with:
Topical antibiotics
Oral antibiotics
Humira (adalimumab), a biologic drug that reduces inflammation by blocking the immune system
Anti-androgen drugs like birth control pills in women or spironolactone
Surgery
Severe cases of hidradenitis suppurativa are treated with:
Topical antibiotics
Humira (adalimumab) or other immunosuppressants, such as Cosentyx (secukinumab) and Remicade (infliximab)
Surgery
Surgery is used to eliminate diseased follicles, abscesses, and sinus tracts. The most common surgeries for HS are:
Incision and drainage
Punch debridement to remove the diseased hair follicle and sweat gland
Unroofing or deroofing, which is when the skin above a lesion is cut off, and the diseased skin below is scraped away
Electrosurgical peeling
Laser excision
Laser hair removal
Wide excision, which is when the entire area of skin is removed and replaced by a skin graft
Treatment options for HS pain include topical anesthetics, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, SNRIs, gabapentin, and, in the worst cases, opioids.
To prevent future outbreaks and disease worsening, clinicians will counsel patients to lose weight, stop smoking, and wear loose-fitting clothing over the affected area.
People with HS aren’t helpless. They can take some control over the disease and its progress by making a few lifestyle changes and taking care of themselves. Here are a few tips:
Wear loose-fitting, breathable, and absorbent clothing around the affected area
Use deodorants, soaps, laundry detergent, and skincare products that do not irritate the skin
Avoid harsh skin-cleaning tools like loofahs
Avoid shaving or waxing an area that has lesions
Avoid heat and humidity
Treat and dress lesions as instructed by a doctor or dermatologist
Although HS is chronic and unpredictable in its course, healthcare professionals believe that treatment at an early stage leads to better outcomes. While the disease can worsen, it doesn’t always do so. When pimples or nodules first appear in a place where they shouldn’t, like the armpits, talk to a healthcare professional. A dermatologist is the best choice. Once diagnosed, do your part by following the doctor’s advice about weight loss, smoking, stress, and clothing.
Hidradenitis suppurativa lesions start when a follicle is blocked. This can be brought on by sweating, humidity, or friction due to tight clothing, skin rubbing, or excess fat. Stress is also known to trigger or worsen HS symptoms.
Dermatologists and other healthcare providers look at HS lesions and determine their severity by assigning what they see to a stage called the Hurley Stage. The earliest stage involves isolated nodules, bumps, and possibly abscesses in the affected area. Stage II involves more nodules and abscesses in the affected area, with the beginnings of tunnels extending out from the abscesses. There may be some scarring already present. Stage III involves extensive coverage of the affected area with abscesses, nodules, and tunnels connecting the abscesses. Scarring can be very severe.
HS is a chronic skin condition and can cause disability because of pain, severe symptoms, or complications like joint pain or limited mobility. If these problems do not improve with treatment and make working impossible, people can qualify for disability.
Hidradenitis suppurativa, StatPearls
Hidradenitis suppurativa: a treatment challenge, American Family Physician
Hidradenitis suppurativa: from pathogenesis to diagnosis and treatment, Clinical, Cosmetic, and Investigational Dermatology
Hidradenitis suppurativa, StatPearls
Hidradenitis suppurativa: rapid evidence review, American Family Physician
Hidradenitis suppurativa: what it is, causes, presentation, and more, Osmosis
North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations, Journal of the American Academy of Dermatology (JAAD)
Treatment: home remedies, HSDisease.com
Hidradenitis suppurativa: current understanding of pathogenic mechanisms and suggestion for treatment algorithm, Frontiers in Medicine
Acne treatments and medications, SingleCare
Folliculitis treatments and medications, SingleCare
Josephine Bawab, Pharm.D., graduated from Virginia Commonwealth University School of Pharmacy. She began working in community pharmacy in 2012 and has worked for multiple chain pharmacies since then. She is passionate about helping patients and precepting students. She currently works and resides in Virginia, where she is just a few minutes away from the beach.
...(Except Major Holidays)
© 2024 SingleCare Administrators. All Rights Reserved.
* Prescription savings vary by prescription and by pharmacy, and may reach up to 80% off cash price.
Pharmacy names, logos, brands, and other trademarks are the property of their respective owners.
This article is not medical advice. It is intended for general informational purposes and is not meant to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, immediately call your physician or dial 911.
This is a prescription discount plan. This is NOT insurance nor a Medicare prescription drug plan. The range of prescription discounts provided under this discount plan will vary depending on the prescription and pharmacy where the prescription is purchased and can be up to 80% off the cash price. You are fully responsible for paying your prescriptions at the pharmacy at the time of service, but you will be entitled to receive a discount from the pharmacy in accordance with the specific pre-negotiated discounted rate schedule. Pharmacy names, logos, brands, and other trademarks are the property of their respective owners.Towers Administrators LLC (operating as 'SingleCare Administrators') is the authorized prescription discount plan organization with its administrative office located at 4510 Cox Road, Suite 111, Glen Allen, VA 23060. SingleCare Services LLC ('SingleCare') is the vendor of the prescription discount plan, including their website.website at www.singlecare.com. For additional information, including an up-to-date list of pharmacies, or assistance with any problems related to this prescription drug discount plan, please contact customer service toll free at 844-234-3057, 24 hours a day, 7 days a week (except major holidays). By using the SingleCare prescription discount card or app, you agree to the SingleCare Terms and Conditions found at https://www.singlecare.com/terms-and-conditions
© 2024 SingleCare Administrators. All Rights Reserved.