Hidradenitis suppurativa (HS) is a long-term inflammatory skin condition that produces painful lumps deep within the skin. Also known as acne inversa, this disorder involves the hair follicles, often begins after puberty, and can persist for many years. The condition is not contagious. A combination of medical treatments and lifestyle adjustments can help manage symptoms and reduce the frequency of flare-ups.
Symptoms and Physical Manifestations
The primary sign of hidradenitis suppurativa is the development of painful, pea-sized lumps under the skin. These nodules appear in areas where skin rubs against skin, such as the armpits, groin, buttocks, and underneath the breasts. A person might first notice a single, persistent lump that lasts for weeks or months before more form.
These initial lesions can progress into larger, inflamed abscesses that fill with pus. When these abscesses break open, they release a fluid that may have an odor. This cycle of inflammation and rupture can lead to the formation of tunnels, known as sinus tracts, which connect the abscesses under the skin and drain slowly.
As the skin repeatedly heals from these events, significant scarring can occur. The skin might develop pitted areas, sometimes with paired blackheads. To classify the severity, healthcare providers use the Hurley staging system. Stage I involves abscesses without sinus tracts or scarring. Stage II is characterized by recurrent abscesses with tract formation and scarring, while Stage III represents widespread involvement with multiple interconnected tracts.
Causes and Contributing Factors
The precise cause of hidradenitis suppurativa is not fully understood, but the condition is thought to begin with blocked hair follicles. This blockage is followed by an overactive immune system response, which drives the inflammation that leads to painful nodules and abscesses. This process is not an infection, though secondary infections can occur in the affected areas.
Genetics play a role, as about one-third of individuals with HS have a family member with the condition. Hormonal fluctuations are also a contributing factor, as many women experience worsening symptoms related to their menstrual cycles. This pattern suggests that sex hormones may influence the activity of the hair follicles.
The condition is not caused by poor personal hygiene or a sexually transmitted disease. Understanding that HS is an inflammatory disorder, rather than an issue of cleanliness, is an important step for those affected.
Diagnosis and Medical Treatments
Diagnosing hidradenitis suppurativa relies on a physical examination by a dermatologist. The diagnosis is based on the characteristic appearance of the lesions, their location in areas like the armpits and groin, and their recurrent nature. A doctor will look for painful nodules, abscesses, sinus tracts, and scarring to confirm the condition.
Treatment for HS is individualized to manage symptoms and prevent new outbreaks. For mild cases, topical treatments are a first step. These can include antibiotic creams like clindamycin or medicated washes applied to the skin’s surface to reduce bacteria and inflammation.
When the condition is more widespread or severe, oral medications are prescribed. Antibiotics, such as those from the tetracycline family, are used for their anti-inflammatory properties. For some, retinoids may be used to regulate skin cell growth, while hormonal therapies can be effective for women whose symptoms fluctuate with their menstrual cycle.
For moderate to severe HS that does not respond to other treatments, biologic drugs offer a targeted approach. Adalimumab is a biologic medication FDA-approved for HS that works by targeting the immune system to reduce inflammation. Procedural interventions can also provide relief, including incision and drainage of an abscess or surgical excision to remove affected tissue.
Lifestyle and Home Management Strategies
In addition to medical treatments, certain lifestyle and home-based strategies can help individuals manage their hidradenitis suppurativa. Careful wound care for draining lesions is important to keep the areas clean. Using warm compresses on painful lumps can alleviate discomfort and may encourage smaller abscesses to drain.
Wearing loose-fitting garments made from breathable fabrics can reduce skin irritation in affected areas like the armpits and groin. Tight waistbands and synthetic materials that trap moisture can exacerbate symptoms and should be avoided when possible.
Lifestyle modifications are a component of managing HS. Since smoking is strongly linked to the condition, quitting can have a positive impact on reducing flare-ups. Maintaining a moderate weight can lessen the skin-on-skin friction that triggers lesions and may also help reduce overall inflammation.
Some individuals find that certain dietary changes help manage their symptoms. Anecdotal evidence suggests that avoiding dairy products or foods containing brewer’s yeast may reduce flare-ups for some people. It is recommended to discuss any significant dietary changes with a healthcare provider to ensure a balanced approach.