Hidradenitis Suppurativa

The symptoms, causes, and treatments of this painful skin condition

hidradenitis suppurativa
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Hidradenitis suppurativa is a chronic, scarring skin disease that affects the apocrine, or sweat glands. It is a common condition but is frequently misdiagnosed and can be disabling and distressing for the person who is affected.

Hidradenitis suppurativa does not occur before puberty. Rather, most people are between 20 and 40 years old when they develop it. Also, women are three times more likely than men to develop it, according to the American Academy of Dermatology.

What Causes Hidradenitis Suppurativa?

The exact cause of hidradenitis suppurativa is disputed. Since it looks similar to acne, some scientists believe that it is caused by the formation of keratin plugs in the follicles. That being said, because hidradenitis suppurativa occurs in areas that contain apocrine, or sweat, glands, other scientists believe that it is caused by a blockage of the apocrine gland.

In either case, the plugged gland or follicle becomes larger, ruptures, and becomes infected. Obesity and cigarette smoking may be triggering factors. 

What the Skin Condition Looks Like—and Where It Occurs

Hidradenitis suppurativa occurs in areas of the body that contain sweat glands including the armpits, groin, upper thighs, buttocks, scalp, and under the female breasts. When the condition is mild, it may present only as a cluster of two or three blackheads that communicate under the skin.

Once the disease begins, though, it gets progressively worse. The extensive, deep inflammation leads to painful abscesses. These abscesses heal incompletely and cause cord-like scars on the skin. In addition, the infection can progress under the skin in tracts linking the abscesses. These boils can be very painful and restrict movement of the affected area.

How Hidradenitis Suppurativa Is Diagnosed

Hidradenitis suppurativa is diagnosed by a doctor based on its appearance. There are no lab tests or biopsies that establish the diagnosis. In the early stages, it can be misdiagnosed as isolated boils.

Many people are embarrassed by the multiple infections, thinking that they have ingrown hairs in sensitive areas. There can also be a bad smell that leaks out of the breakouts, which resemble multiple pimples or boils. Due to this embarrassment, some people do not go to the health care provider until the boils have become numerous or intolerable. If you have hidradenitis suppurativa, it's important to know, though, that this skin condition is not your fault. Also, it cannot be spread to others and it is not a result of poor hygiene.

Common Treatment Options

Treating hidradenitis suppurativa is difficult. It is best treated in the early stages before extensive scarring develops. However, it must be diagnosed correctly. The following are some common treatment options.

  • Antibiotics: Oral antibiotics (those taken by mouth) may help suppress the inflammation, especially in mild cases, but they do not cure the disease. The same antibiotics that are used for acne are used for hidradenitis suppurativa, only in higher doses. These antibiotics include erythromycin, tetracycline, minocycline, and doxycycline. Topical antibiotics (those applied to the skin) do not help.
  • Isotretinoin (Accutane): Isotretinoin may be helpful in mild cases, but the response is unpredictable. Sometimes isotretinoin is used to reduce the size of the affected areas prior to surgery. Isotretinoin does have significant side effects and must not be used by pregnant women.
  • Steroid injection: Injecting a steroid into an inflamed lesion is sometimes helpful. The injection helps reduce inflammation and may be used if an area is especially painful. Steroid injections are normally combined with other treatments.
  • Surgery: In moderate-to-severe cases of hidradenitis suppurativa, surgery is the most definitive option. That being said, taking out only the immediately affected area only leads to recurrence of the disease. Instead, the treatment of choice is called wide local excision. In this procedure, the affected area and the surrounding normal tissue are surgically excised. The excision is not stitched back together but left open to heal from the inside out. Skin grafts may be placed in the excised area to speed healing.
  • Adalimumab (Humira) was FDA approved in 2015 for people ages 12 and older who have moderate to severe AS. It is a biologic agent that helps reduce inflammation. In clinical trials, this option has also shown that it can improve nodules and abscesses that come with hidradenitis.

A Word From Verywell

If you suspect that you or a loved one has hidradenitis suppurativa or another painful skin condition (like frequent boils or acne-like cysts), please see a dermatologist for a proper diagnosis. Early diagnosis of hidradenitis suppurative is essential in preventing it from getting worse. 

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