Hidradenitis Suppurativa

Overview

Definition

Hidradenitis suppurativa (HS) is long term, recurring condition of the hair follicle. Inflamed nodes and cysts form in the armpits and groin. These may also be found under the breasts, and around the nipples, and anus. Other areas may be affected, but this isn’t common.

Skin, Hair, Hair Follicle
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Causes

The hair follicle becomes blocked causing inflammation. This may lead to abscesses, infection, or scars. The sweat glands may also become inflamed.

A mix of factors lead to HS such as:

  • Genetics
  • An overactive immune system
  • How hormones act on the body

Risk Factors

HS is more common in women than in men. Your chances of HS are also higher if you:

  • Have a family history
  • Smoke—present or past
  • Are overweight
  • Have diabetes
  • Have metabolic syndrome—marked by raised blood pressure, cholesterol, blood glucose, and body weight
  • Have problems with cholesterol

SymptomsandDiagnosis

Symptoms

Most people with HS have problems after adolescence. But HS can happen at any age. HS may cause:

  • Burning, itching, or painful lumps in the armpits, groin, under the breasts, around the nipples or anus, and other involved areas
  • Pus leaking from breaks in the lumps
  • Scarring

Diagnosis

The doctor will ask about your symptoms and health history. Your answers and a physical exam may point to HS. In some cases, you may have blood tests or swabs of the fluid from your skin.

Treatments

Treatment

The goal of care is to control outbreaks. Care may involve:

Home Care and Lifestyle Changes

Making changes may help you lower your chances of an outbreak:

  • Lose extra weight—talk to a dietitian who can help you do it safely
  • Quit smoking—your doctor can help you find a plan to successfully quit
  • Try to stay cool to lower the chances of sweating
  • Stay away from heat or humidity when you can
  • Wear loose clothing that won’t rub on your skin
  • If your skin is irritated, don’t shave until it’s better

Talk to your doctor about customized bandaging

Medications

Your doctor may advise:

  • Antibiotics
  • Medicines to lower the effects of the immune system such as:
    • Corticosteroids
    • Biologic agents
    • Retinoids
    • Hormonal therapy

Medicines may be as a pill, rubbed into the skin, or given as a shot.

Surgery

If other methods don’t work, surgery may be an option. Methods of surgery:

Other procedure options include:

  • Laser—uses heat to remove lesions
  • Cryosurgery—uses cold to remove lesions
  • Laser hair removal
  • Skin graft

Prevention

There is no way to prevent HS because the exact cause is unknown.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

a (Acne Conglobata; Acne Inversa [AI]; Apocrine Acne; Apocrinitis; Fox-Den Disease; HS; Hydradenitis Suppurativa; Pyodermia Significa Fistulans; Velpeau's Disease; Verneuil's Disease)

RESOURCES

American Academy of Dermatology https://www.aad.org 

Hidradenitis Suppurativa Foundation http://www.hs-foundation.org 

CANADIAN RESOURCES

Canadian Dermatology Association https://www.dermatology.ca 

Health Canada https://www.canada.ca 

References

Fardet L, Dupuy A, Kerob D, et al. Infliximab for severe hidradenitis suppurativa: transient clinical efficacy in seven consecutive patients. J Am Acad Dermatol. 2007;56:624-628.

Hidradenitis suppurativa. EBSCO DynaMed Plus website. Available at:  http://www.dynamed.com/topics/dmp~AN~T115217/Hidradenitis-suppurativa . Updated August 9, 2016. Accessed June 19, 2018.

Hidradenitis suppurativa. NORD—National Organization of Rare Diseases website. Available at: https://rarediseases.org/rare-diseases/hidradenitis-suppurativa. Updated 2012. Accessed June 19, 2018.

Lam J, Krakowski AC, Friedlander SF. Hidradenitis suppurativa (acne inversa): management of a recalcitrant disease. Pediatr Dermatol. 2007;24(5):465-473.

Shah N. Hidradenitis suppurativa: a treatment challenge. Am Fam Physician. 2005;72(8):1547-1552.

11/30/2015 DynaMed Plus Systematic Literature Surveillance  http://www.dynamed.com/topics/dmp~AN~T115217/Hidradenitis-suppurativa : Tzellos T, Zouboulis CC, Gulliver W, et al. Cardiovascular disease risk factors in patients with hidradenitis suppurativa: a systematic review and meta-analysis of observational studies. Br J Dermatol 2015;173(5):1142-1155.