Hidradenitis Suppurativa

What is hidradenitis suppurativa?

Hidradenitis suppurativa, often shortened to HS, is a chronic inflammatory skin disease that causes painful bumps, nodules, abscesses, and draining areas in places where skin rubs together. Common sites include the underarms, groin, buttocks, inner thighs, and under the breasts.

HS is not simply a hygiene problem, and it is not just a series of ordinary boils. It is a long-term inflammatory condition that can scar over time and can have a major effect on pain, daily life, and confidence.

What causes hidradenitis suppurativa?

HS develops through a combination of follicular blockage, inflammation, genetics, and immune-system activity. It often begins after puberty and may flare on and off over time.

Known triggers or risk factors for HS encompass:

• Hormonal Factors: Predominantly affecting women

• Obesity: A significant contributing factor

• Family History: Having relatives with HS increases risk

• Smoking: Raises susceptibility

• Clothing and Friction: Tight garments and chafing from skin folds

• Shaving: Particularly in the affected areas

• Autoimmune Disorders: Like inflammatory bowel disease

• Certain Medications

• Climatic Factors: Hot and humid weather can exacerbate symptoms

What are the symptoms of hidradenitis suppurativa?

Symptoms can include:

• Painful lumps under the skin

• Recurrent boils or abscess-like lesions

• Drainage from inflamed areas

• Tunnels under the skin, also called sinus tracts

• Scarring and dark marks after flares

• Tenderness, soreness, and limitation of movement in affected areas

HS can range from occasional isolated nodules to widespread, recurrent disease with scarring.

How is hidradenitis suppurativa treated?

Effective management of HS entails prevention, self-care, and lifestyle modifications, but medical intervention is often imperative. Potential treatments include:

Medications:

• Antibiotics (oral forms like rifampicin/clindamycin, dapsone and topical clindamycin)

• Hormonal treatments (birth control pills, spironolactone, finasteride)

• Steroids (both injectable and oral forms for acute flare-ups)

• Diabetes drug, Metformin

• Acne medication, Isotretinoin

• Immune-regulating drugs (methotrexate, cyclosporine, azathioprine)

• Biologic treatments like adalimumab (Humira), infliximab (Remicade), secukinumab (Cosentyx), bimekizumab (Bimzelx) and JAK inhibitors

Surgical Options:

• Draining of acute abscesses

• Curettage and de-roofing of nodules, abscesses and sinuses

• Laser ablation of nodules, abscesses and sinuses (typically not covered by insurance)

• Surgical excision for persistent nodules

How do I prevent hidradenitis suppurativa flares?

Medication might be necessary for flare prevention, but individuals can also:

• Adopt a healthy weight

• Embrace an anti-inflammatory, plant-based diet low in sugars, grains, and dairy

• Cease smoking

• Choose loose clothing

• Use fragrance-free antiperspirants daily

• Maintain hygiene through antiseptic washes or bleach baths

• Warm baths to soothe affected areas