Hidradenitis Suppurativa Treatment

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Hidradenitis Suppurativa Treatment

What is hidradenitis suppurativa?

Hidradenitis suppurativa (hi-drad-uh-NIE-tis sup-yoo-ruh-TIE-vuh) (HS) is a chronic (long term) skin condition that causes small, painful, swollen lumps or lesions to form under the skin. HS is most common in areas where skin rubs together, like armpits, groin, buttocks and breasts. Usually starting after puberty, it can persist for many years, getting progressively worse. HS is caused by infected and/or inflamed, clogged hair follicles or sweat glands. It can be extremely painful and debilitating. To prevent complications, it’s treated with medications or a combination of medications and surgery in severe cases. Without treatment, it can become disabling, and cause emotional distress. There is no cure for HS.

Should I be worried about hidradenitis suppurativa?

If mild cases are included, HS occurs in about 1% of the population. It is three times more common in women than men. It must be treated or managed to keep it from getting worse. HS cannot be spread to other people. It becomes life-threatening only if a bacterial infection is not controlled, causing an infection throughout the body (systemic infection) in people who have weakened immune systems. It can last many years, alternating between improvement and worsening symptoms.

Causes

What causes hidradenitis suppurativa?

While the underlying cause of HS is not known, a combination of genetic and environmental factors can trigger it. Some patients have an inherited tendency to develop the disease. Abnormal gland development may be another cause of HS. 

Most often occurring after puberty, HS rarely occurs after age 40 or before puberty. It is during puberty that the surge of hormones causes changes in hair follicles. Follicles are tiny sacs within the skin from which each hair grows. If follicles become blocked or clogged, it can result in tender or painful, reddish bumps. As bacterial infection and inflammation progress, pus-filled pits of infection (abscesses) develop. If the follicles rupture, the infection spreads, often causing scars.

Flare-ups of HS can be triggered by:

  • Women’s menstrual periods
  • Weight gain
  • Stress
  • Hormonal changes
  • Inflammation of sweat glands
  • Heat
  • Perspiration
  • Cigarette smoking 

Who’s at risk for developing hidradenitis suppurativa?

Risk for HS is highest for:

  • People in their teens, 20s and 30s
  • Women
  • Black people
  • Overweight people
  • People with severe acne
  • People who have arthritis, diabetes, metabolic syndrome, or inflammatory bowel disease
  • Tobacco smokers

With Insurance

Dermatology

Your copay
Depending on insurance

Without Insurance

Dermatology

$89

Initial Visit

$75

Follow Up

Symptoms

What are the symptoms of hidradenitis suppurativa?

Some people have only mild symptoms that can be treated at home. However, symptoms can progress to a severe level, and affect one or several areas of the body. There are three stages of severity for HS.

Symptoms can include:

  • Initially, stage one of HS causes itching or discomfort that precede the symptoms listed here
  • Blackheads, often developing in pairs
  • Skin eruptions that look like boils, can develop into sores or pus-filled abscesses
  • In stage two of the disease, abscesses develop into hard, painful, pea-sized lumps that last for weeks or months; more bumps develop with time
  • Deep-seated abscesses can form into clusters of skin lesions that spontaneously break open and drain pus with a bad odor
  • Ropelike scars or pitted skin are left after the affected areas heal
  • In stage three (severe cases) of HS, widespread and chronic “tunnels” develop under the skin between the lumps; they heal very slowly or not at all, draining blood and pus
  • Tunnels may heal and then return, causing progressive scarring; scars feel like thick, cordlike bands under the skin
  • Tunnels can entrap sweat and bacteria in the surrounding tissues; resulting in more infection and inflammation
  • Severe cases can be painful and debilitating; movement is limited because of scar tissue, especially in armpits or groin areas

Serious complications can develop from long-term or untreated HS. 

Complications can include:

  • Painful, debilitating scarring that restricts movement.
  • Swelling of the arms, legs or genital area, and areas with many lymph nodes. Scar tissue can limit normal drainage of the lymph system.
  • Skin cancer (squamous cell carcinoma) can occur in patients with chronic HS.
  • Psychological stress and social isolation are not uncommon. Due to the embarrassment of the sores, their drainage and odor, patients don’t want to leave their homes. Anxiety and depression can result.

Diagnosis

How is hidradenitis suppurativa diagnosed?

Far too often, HS is not diagnosed for years because patients are too embarrassed about their symptoms. It’s very important to have an early diagnosis when symptoms first appear. It helps you get effective treatment before the disease worsens. 

Your HS healthcare team should include medical and surgical dermatologists (doctors who specialize in skin treatment), along with other healthcare professionals. HS is difficult to diagnose and requires specialized treatment and management. 

Diagnosis will be based on your symptoms, skin appearance and medical history. Blood tests and, if drainage or pus is present, a sample will be sent to a lab for a culture test. This can rule out other skin conditions. Another testing may include ultrasound of hair follicles and skin thickness to find abnormalities. Ultrasound can also track the progress of HS. Other tests include C-reactive protein assay, urine tests, complete blood count with differential and platelet counts, and others.

See your dermatologist if, with the first symptoms, you have pain, restricted movement, frequent flare-ups, or it doesn’t improve within a few weeks. If the symptoms return within a few weeks of treatment or spread to several locations, you need an early diagnosis to ensure early treatment.

Treatment

How do you treat hidradenitis suppurativa?

Getting treatment early for HS will help manage symptoms, and prevent new boils and abscesses from forming. You’ll need regular follow-up visits with a dermatologist to manage the disease and help keep it under control. 

Treatments may work for some patients but not others. Treatment depends on the stage of HS when it’s first diagnosed. Each stage requires different treatment. 

Mild cases can be treated at home with warm compresses, keeping the skin clean and dry, antibacterial soaps and antiseptics. Anti-inflammatory medication and wearing loose clothing made of natural fabrics can also help. It’s also important to maintain a healthy weight and avoid smoking and second-hand smoke. Being overweight causes more friction and irritation to the skin, plus excessive sweating. Both friction and sweat cause HS flare-ups.

Daily medication can prevent progression to severe stage 3 of HS. Your dermatologist may prescribe one or more of these medications:

  • Antibiotics are applied to the skin (topically) for mild cases.
  • Antibiotics are taken by mouth for infection over a wide area; may be required for months.
  • Steroids injected directly into the sores can reduce swelling and inflammation.
  • Anti-inflammatory drugs can help with swelling.
  • Biologics can alter the immune system to stop the disease cycle, improving symptoms within weeks.
  • Retinoids can help with acne-like forms of HS.
  • Over-the-counter pain relievers can help; or you may require a stronger, prescription pain medication. 

Surgery may be needed for severe cases, and cases not helped by medications. If you have tunnels and abscesses, these surgical options might be recommended:

  • Punch debridement is a term meaning a single inflamed bump is removed.
  • Uncovering the tunnels requires that skin be removed to expose them.
  • Laser therapy is used to make the sores go away, and not likely to return.
  • Surgical skin removal of all the affected skin is used for persistent or severe cases. Skin grafts may be needed to close the wounds. Sores may later break out in other areas.

References

Mayo Clinic. (Aug. 2021) Hidradenitis Suppurativa. Retrieved 9-17-21, {https://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/symptoms-causes/syc-20352306}
National Organization for Rare Disorders. (Sept. 2012). Hidradenitis Suppurativa. Retrieved 9-17-21, {https://rarediseases.org/rare-diseases/hidradenitis-suppurativa/}

Information

Medically reviewed by:

Dr. Javeed Siddiqui, MD, MPH

Dr. Siddiqui is the Chief Medical Officer at TeleMed2U responsible for clinical and technical program development as well as maintaining a thriving telemedicine practice in infectious diseases which includes specialized care of Hepatitis and HIV.

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Affordable –
with or without insurance

With Insurance

Dermatology

Your copay
Depending on insurance

Without Insurance

Dermatology

$89

Initial Visit

$75

Follow Up