About hidradenitis suppurativa

What is hidradenitis suppurativa?

Hidradenitis suppurativa (hi-drad-uh-NIE-tis sup-yoo-ruh-TIE-vuh) is rare, long-term skin condition that features small, painful lumps under the skin. They typically develop where the skin rubs together, such as the armpits, the groin, between the buttocks and under the breasts. The lumps may break open and smell or cause tunnels under the skin.

Hidradenitis suppurativa tends to start after puberty. It can persist for many years and worsen over time, with serious effects on your daily life and emotional well-being. Early diagnosis and treatment can help manage the symptoms, keep new lumps from forming and prevent complications, such as scarring or depression.

What are the symptoms for hidradenitis suppurativa?

Hidradenitis suppurativa commonly occurs around hair follicles with many oil and sweat glands, such as in the armpits, groin and anal area. It may also occur where skin rubs together, such as the inner thighs, under the breasts and between the buttocks. Hidradenitis suppurativa can affect one spot or multiple areas of the body.

Signs and symptoms of hidradenitis suppurativa include:

  • Blackheads. Small pitted areas of skin containing heads — often appearing in pairs or a "double-barreled" pattern — are a common feature.
  • Red, tender bumps. These Bumps often enlarge, break open and drain pus. The drainage may have an odor. Itching and Burning may accompany the bumps. They usually appear in areas where skin rubs against skin.
  • Painful, pea-sized lumps. These hard lumps, which develop under the skin, may persist for years, enlarge and become inflamed.
  • Tunnels. Over time, tracts connecting the lumps may form under the skin. These wounds heal very slowly, if at all, and can leak pus.

Hidradenitis suppurativa usually starts between puberty and age 40 with a single, painful bump that persists for weeks or months. For some people, the disease progressively worsens and affects multiple areas of their body. Other people experience only mild symptoms. Excess weight, stress, hormonal changes, heat or humidity can worsen symptoms. In women, the disease severity may lessen after menopause.

When to see a doctor

Early detection of hidradenitis suppurativa is key to getting effective treatment. See your doctor if your condition:

  • Is painful
  • Doesn't improve in a few weeks
  • Returns within weeks of treatment
  • Appears in several locations
  • Recurs often

If you've already received a diagnosis of hidradenitis suppurativa, keep in mind that the warning signs of a disease flare (recurrence) are often similar to those that occurred originally. Also pay attention to any new signs or symptoms. These may indicate either a recurrence or a complication of treatment.

What are the causes for hidradenitis suppurativa?

Hidradenitis suppurativa develops when hair follicles become blocked and inflamed. No one knows exactly why this blockage occurs. Factors that may play a role include hormones, metabolic syndrome, genetics, an irregular immune system response, smoking and excess weight.

Hidradenitis suppurativa is not caused by an infection and can't be transmitted sexually. It's not contagious and is not due to poor hygiene.

What are the treatments for hidradenitis suppurativa?

There is no cure for hidradenitis suppurativa. But early and long-term treatment may help control pain, promote wound healing, keep new lumps from forming and prevent complications.

Several treatment options are available. Talk with your doctor about the risks and benefits of each and which combination of self-care, drugs or surgical procedures are right for you.


Your doctor might prescribe one or more of the following types of medications:

  • Topical and oral drugs. These include antibiotics and drugs derived from vitamin A (retinoids).
  • Other drugs that reduce inflammation. Injecting steroid medications directly into the tender nodule can reduce inflammation. Oral steroids, such as prednisone, can also help. But long-term use of prednisone has many side effects, including bone thinning (osteoporosis).
  • Hormones. Small studies comparing oral antibiotics with hormonal therapy showed the hormonal therapy to be as effective as antibiotics in treating sores of hidradenitis suppurativa. Further study is needed. Hormonal therapy is not suitable for pregnant women due to the risk of side effects.
  • Drugs that suppress the immune system. The drugs infliximab (Remicade) and adalimumab (Humira) show promise in the treatment of hidradenitis suppurativa. These "biologics" are TNF inhibitors. They work by neutralizing an immune system protein known as tumor necrosis factor (TNF). Researchers continue to assess these and similar drugs. Possible side effects include an increased risk of infection, heart failure and certain types of cancers.
  • Pain medication. If over-the-counter pain relievers don't help, your doctor may prescribe a stronger type. Examples include a fentanyl patch, codeine, morphine, gabapentin and pregabalin.

Surgery and other procedures

Hidradenitis suppurativa may be treated with various surgical approaches. The method used depends on the extent and location of the wounds, among other factors.

  • Uncovering the tunnels. Known as unroofing, this procedure is gaining favor over incision and drainage. Your doctor cuts away the skin and flesh that cover any interconnected tunnels. This solution usually doesn't have to be repeated.
  • Punch debridement. This procedure is also called mini-unroofing and may be used to remove a single inflamed nodule.
  • Incision and drainage. Surgical drainage may be an option when the disease involves a single small area. This treatment generally provides short-term pain relief, but the sores tend to recur.
  • Tissue-sparing excision with electrosurgery. This may be an option for people with severe hidradenitis suppurativa. It combines skin-tissue-sparing excision with electrosurgical peeling (STEEP). The goal is to remove diseased tissue and preserve healthy tissue. You will be given general anesthesia for the STEEP procedure.
  • Surgical removal. Surgical treatment of recurrent or severe symptoms involves removal of all involved skin. A skin graft may be necessary to close the wound. Even after you have surgery, sores may still occur in other areas. In men whose condition involves the area between the anus and scrotum, surgical removal of the scrotum is almost always necessary.

What are the risk factors for hidradenitis suppurativa?

Factors that may increase your risk may include:

  • Age. Hidradenitis suppurativa most commonly occurs in women between the ages of 20 and 29. An early age of onset may be associated with developing more widespread disease.
  • Your sex. Women are more likely to develop hidradenitis suppurativa than are men.
  • Family history. A tendency to develop hidradenitis suppurativa can be inherited.
  • Having certain other conditions. Hidradenitis suppurativa can be associated with several other conditions, including arthritis, severe acne, obesity, inflammatory bowel disease, Crohn's disease, metabolic syndrome and diabetes.
  • Smoking. Smoking tobacco has been linked to hidradenitis suppurativa.

Is there a cure/medications for hidradenitis suppurativa?

Hidradenitis suppurativa is an inflammatory skin disease that causes painful, pus-filled cysts to form in the sweat glands around the groin, armpits, and breasts, primarily around the hair follicles. It happens when hair follicles become obstructed. This particular skin condition is common from puberty until mid-life. And it disproportionately affects women. The severity and specific symptoms of Hidradenitis suppurativa differ between individuals.

There are several effective treatments for hidradenitis suppurativa that allow you to manage your symptoms with or without the use of medication or surgery. The following are some of the most effective HS treatments.

  • HS symptoms can range from mild to severe, and conventional treatments rarely work. It is important to note that hidradenitis suppurativa is not caused by an infection or being unsanitary, and it is not contagious.
  • Depending on the severity of the symptoms, dermatologists may recommend oral antibiotics or liquid gels.
  • Anti-inflammatory drugs may also be prescribed to reduce swelling and pain.
  • This skin condition can also be caused by environmental and behavioral factors.
  • Obesity and smoking are common among people with hidradenitis suppurativa.
  • Avoiding tight clothing, harsh products, and rubbing the affected area's skin can lead to infection.
  • If all other treatments are ineffective, surgery is the last resort.

Intense pain and discomfort in the affected region,Redness,Pus-filled cyst,Ulcers,Frictional pain
The affected areas are prone to infection, which can lead to skin cancer,Scarring may also develop
Antibiotics (doxycycline, clindamycin, rifampin),Hormone therapy,Immune modulator (Biologics)

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