Hidradenitis suppurativa, also known as acne inversa, is an inflammatory disease that causes bumps to appear on the skin. While these bumps may resemble pimples or boils, they typically appear in places where acne does not, such as the underarms and groin.
Many people have HS for life. When the condition is diagnosed early, a board-certified dermatologist can recommend effective treatment options to help control the symptoms and prevent the condition from getting worse.
WHAT DOES HS LOOK LIKE?
If you have HS, you will notice bumps on your body in areas where skin touches skin. This condition is most common in the underarms and groin. It also may appear on and under the breasts, on the buttocks, and around the anus.
HS bumps may look like pimples, deep acne-like cysts or blackheads, folliculitis (swollen pimples with a hair in the center), or boils. If they break open or rupture, the bumps can leak a blood-stained, foul-smelling pus.
As HS gets worse, the bumps can grow larger and become painful, hot and tender. As the bumps heal, they can
cause deep scars that look like tunnels under the skin. These scars can thicken over time and may be painful. Because of the scarring and pain associated with HS, patients may experience a limited range of motion in areas where the bumps appear.
WHO GETS HS?
Although HS can affect people of any age, it is most common in individuals between the ages of 15 and 30. Women, people who are overweight or obese, and smokers have a higher risk of developing HS than the general population. Your risk also increases if you have a blood relative with HS.
WHAT CAUSES HS?
HS forms when hair follicles and certain sweat glands become clogged with dead skin cells and other substances. While researchers have not determined the exact cause of HS, scientists believe that it may develop when the immune system overreacts to these clogged hair follicles. Dermatologists do know that HS is not contagious and that it is not caused by poor hygiene.
HOW DOES A BOARD-CERTIFIED DERMATOLOGIST DIAGNOSE HS?
While HS can look like acne, boils and other skin diseases, the trained eye of a board-certified dermatologist can distinguish among these conditions. To diagnose HS, the dermatologist will look at your skin and ask specific questions. If your HS sores are leaking fluid, the doctor may swab some of this fluid to see if there is an infection.
HOW DOES A BOARD-CERTIFIED DERMATOLOGIST TREAT HS?
There are a variety of treatments for HS. No one treatment works for everyone, and you may need to try multiple treatments to find one that works for you. A board-certified dermatologist can discuss your treatment options with you.
- Antibiotics: Antibiotics, which can be applied to the skin or taken as pills, can be effective in the early stages of HS. They can help fight infection, decrease inflammation, prevent the condition from getting worse and stop future outbreaks.
- Antimicrobial washes and medicines: Antimicrobial washes such as benzoyl peroxide or chlorhexidine, which are available over-the-counter, may be helpful, although they usually will not clear HS on their
- Bleach baths: If you have certain bacteria on the surface of your skin, your dermatologist may recommend taking short bleach baths in your bathtub at home. If a bleach bath is right for you, your dermatologist will provide instructions on how to take one.
- Corticosteroids: Your dermatologist can inject this medicine into an HS bump to help reduce pain and
- Diabetes medication: Metformin, which is approved by the U.S. Food and Drug Administration for the treatment of adult-onset diabetes (type II diabetes), also may help people who have HS and a condition called metabolic syndrome.
- Hormone therapy: Medicines that regulate hormones, including birth control pills and spironolactone, may decrease pain and the amount of fluid draining from HS
- Biologics: Drugs that work on the immune system, including adalimumab, may be used to treat moderate to severe HS. Because of the potentially serious side effects associated with these medications, you should discuss the risks and benefits with your
- Methotrexate: This medicine is used to treat cancer and other medical conditions, such as severe It works on the immune system and may help control HS in some people.
- Oral retinoids: Retinoids can stop the pores from producing too much oil, which helps prevent clogged hair follicles. This treatment will only work for certain
- Radiation therapy: This treatment has resulted in HS improvement for some people in whom all other therapies have failed. Talk to your dermatologist about the short- and long-term risks of exposure to radiation. A long-term risk of radiation is the development of skin
HS can grow deep into the skin and the underlying tissue. When this happens, oral and topical medicines alone may not work. A board-certified dermatologist may recommend one of the following procedures, which he or she can safely perform in the office. Serious cases may require a surgical procedure at a hospital.
- Incision and drainage: A surgical procedure in which your dermatologist drains bumps. This can be helpful for people who have one or two deep and painful lumps. While the procedure can provide short-term relief, the HS usually
- Laser procedures: Laser hair removal devices can treat some cases of HS or prevent new lesions from developing, while another type of laser can be used in a surgical procedure to remove skin in the affected
- Deroofing: This is a surgical procedure in which the dermatologist will open the tracts that develop under the skin, creating a less visible scar. This is an option for people whose HS repeatedly
- Excision or Soft Tissue Resection: This surgical procedure involves removing HS bumps and some surrounding skin. The affected area may be closed or partially closed, or covered with a skin flap or skin graft. While HS usually does not return to the treated spot, new bumps can form
HOW CAN I MANAGE MY HS SYMPTOMS?
Dermatologists recommend the following tips for easing the symptoms of HS:
- Lose weight if you are
- Do not smoke; if you are currently a smoker, take steps to
- Do not shave where HS
- Wear loose-fitting
- Avoid overheating and
A board-certified dermatologist is a medical doctor who specializes in the diagnosis and medical, surgical and cosmetic treatment of skin, hair and nail conditions. To learn more about HS or to find a board-certified dermatologist in your area, visit aad.org/HS or call toll-free (888) 462-DERM (3376).
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Copyright © by the American Academy of Dermatology and the American Academy of Dermatology Association.
Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides
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