Hidradenitis Suppurativa

What is hidradenitis suppurativa? 

Hidradenitis suppurativa, also called acne inversa, is a chronic autoinflammatory skin condition that causes lumps to form under the skin. The painful lumps form deep in the skin often in areas where skin touches skin, like armpits, inner thigh, breasts, and groin. During a flare up, the lumps become infected and inflamed, releasing pus and leaving behind scars. The lumps form in a cycle with periods of active flaring and slow healing.

Since hidradenitis suppurativa mimics other common skin conditions, like infected follicles, abscesses, or boils, people can receive an improper diagnosis. Doctors continue to develop treatment plans for people living with hidradenitis suppurativa and learn more about the root causes of the condition to better identify and treat the condition.

What causes hidradenitis suppurativa?

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Hidradenitis suppurativa starts with blockages in hair follicles, often the result of built-up keratin and sweat. As the follicle continues to fill with debris, the symptomatic nodules form under the skin and become infected with bacteria. When these nodules rupture, the bacteria spreads to nearby hair follicles and results in a flare up of inflammation and pain. Over time, the repeated blockages and ruptures create scars and tunnels deep in the skin, which slows the healing process. 

While doctors understand that the blocked hair follicles prompt the lumps to form, they are still discovering the exact cause of the response. The condition is autoinflammatory, meaning a dysfunction in a person’s immune system causes genes to malfunction and signal an attack on the body. Because the condition stems from a person’s genes, doctors look to hormones, family history, genetics, and environmental factors to learn more about the precise cause. 

It is important to note that a person does not develop hidradenitis suppurativa as a result of poor hygiene or contact with someone who has the condition. You cannot spread the condition by contact, and you cannot prevent developing the condition with topical hygiene products or cleaning routines. 

What are symptoms of hidradenitis suppurativa?

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The first symptoms of hidradenitis suppurativa are the appearance of painful pea-sized lumps in areas with more sweat glands and where skin rubs together. Lumps can appear in one or many areas of the body and resemble a deep pimple, boil, or acne cyst. The nodules typically last for weeks or months then may go away. 

As the condition advances, the lumps will reappear in clusters called abscesses, and they will fill with fluid and become inflamed and painful. The abscesses may burst and release odorous pus or blood. Eventually, the abscess groups will form tunnels known as sinus tracts under the skin, enabling the spread of bacteria to other parts of the body and causing the formation of more lumps. In later stages of hidradenitis suppurativa, blackheads appear in pitted areas of skin often in pairs. 

Symptoms of hidradenitis suppurativa vary from mild to severe depending on the person and the progression of the condition. 

Mild: Mild cases involve a smaller number of lumps but can get worse with time and without treatment. 

Moderate: People with moderate cases will experience more lumps that break open and spread to other parts of the body. 

Severe: Those who have more severe cases of hidradenitis suppurativa are subject to extensive scarring and chronic pain with widespread lumps. 

The course of hidradenitis suppurativa is hard to predict and is highly variable. People may experience all the symptoms of the condition or only a select few. Keeping track of your symptoms can help you and your doctor understand your status and work towards a treatment plan.   

Are there any risk factors or groups for hidradenitis suppurativa?

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There are key risk factors that make some groups of people more likely to develop hidradenitis suppurativa than others. Some risk factors relate to a person’s preexisting conditions while others relate to a person’s demographics. 

The following are common risk factors associated with hidradenitis suppurativa. This list is not complete, for there are other factors that may contribute to a person’s risk. 

Family History: A person with family members who have hidradenitis suppurativa have a higher chance of developing the condition themselves. Roughly 30 to 40% of people with the condition have family members who also have the condition. 

Age: Hidradenitis suppurativa occurs most commonly between the ages of 20 and 40. The cause of the condition may be related to hormones, so periods of fluctuating sex hormones, like puberty and menopause, contribute to a person’s risk of developing the condition. 

Sex: Women and people assigned female at birth are more likely to develop the condition than men and people assigned male at birth. 

Race: Black people have a higher risk of developing hidradenitis suppurativa than white and other racial groups in the United States. 

Pre-Existing Conditions: Several conditions are risk factors for hidradenitis suppurativa. In particular, weight-, skin-, and hormone-related conditions add to a person’s risk of developing this skin condition. Obesity and other metabolic syndromes impact the body’s immune system response and hormone levels. Similarly, skin conditions such as psoriasis predispose a person to hidradenitis suppurativa since the skin is already in a compromised state. 

Smoking: People who smoke are more likely to develop the condition. Smoking introduces many toxins to the body, which can damage the skin and make the skin vulnerable to infection and can make the symptoms of conditions like hidradenitis suppurativa worse. In addition, smoking weakens a person’s immune system, further putting a person at risk. 

This list covered some of the main risk factors and demographic groups that relate to hidradenitis suppurativa. However, because the root cause of the condition is still unknown, some of the risk factors are not clear. 

How is hidradenitis suppurativa diagnosed?

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Hidradenitis suppurativa shares similarities with other conditions, like acne and ingrown hairs, making the diagnosis difficult. In fact, many people live with hidradenitis suppurativa for months to years without knowing. A dermatologist who specializes in skin conditions can diagnose this condition with a review of the patient’s medical history and a physical exam. 

There is no test for hidradenitis suppurativa, so the doctor will rely on asking questions about pre-existing conditions and other risk factors. In addition, the doctor may take a sample of the fluid from the lumps to test for its properties. 

The visual symptoms of the condition can be hard for dermatologists to distinguish by appearance alone. A verbal description of your symptoms and the time frame that the lumps appear and disappear will help the dermatologist give an accurate diagnosis. 

To prep for your appointment, it is useful to answer these questions to have ready to tell you doctor:

  • What symptoms are you experiencing?
  • How long have you been experiencing the symptoms?
  • Where have you noticed the skin lumps?
  • Has anyone in your family had this problem?

How is hidradenitis suppurativa treated?

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Treatment for hidradenitis suppurativa includes medication and skin care to help manage the effects of the condition. Together with your doctor, you can develop a personalized treatment plan to help lessen the symptoms of the condition and improve your quality of life. Most of the treatment options aim to reduce skin irritation, treat infection, and manage pain.  

Medication: Topical medications like antibiotic creams help to reduce inflammation by treating the underlying infection. Other treatments like chemical peels help to unclog the hair follicles. Ingestible medicine helps regulate hormones and the immune system. 

Procedures: In some cases, the doctor may perform a number of in-office procedures to mitigate the effects of the conditions. Examples of these procedures include laser hair removal, steroid injections, and incision and drainage. 

Skin Care: The right skin care and antiperspirant products can help care for your skin and deal with wound management. Your doctor can recommend products that will help with irritation. 

Should you see a doctor for hidradenitis suppurativa?

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Early intervention is best for hidradenitis suppurativa, so you should see a doctor if you notice symptoms start to develop. While hidradenitis suppurativa is not life threatening in most cases, the condition still warrants swift attention. Effective medical attention can help keep the condition from progressing to more severe stages.

Your general practitioner may have to refer you to a dermatologist, who will have specialized knowledge about hidradenitis suppurativa and can help determine your progression.

What is the outlook for people living with hidradenitis suppurativa?

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While hidradenitis suppurativa has no cure, the outlook for people with this condition is generally good. Lifestyle changes and medication can greatly help in pain management and can help your body heal the wounds. Once your doctor has successfully diagnosed hidradenitis suppurativa, you can effectively treat your symptoms. To help improve your condition, you can quit smoking, incorporate healthy foods into your diet, and switch your self care routine to help treat your skin. 

People with hidradenitis suppurativa may develop anxiety and depression as a result of their diagnosis. Constant symptom management and interruptions to their daily routine can be hard to cope with. You may seek therapy or counseling to help cope with your symptoms and learn to live with hidradenitis suppurativa.