Hidradenitis Suppurativa (HS), also known as acne inversa, is a chronic inflammatory skin condition that causes painful, boil-like lumps to form under the skin. This condition often affects areas where skin rubs together, such as the armpits and groin. The lumps become inflamed, can break open, and may drain fluid and pus.
Characteristics of HS Wounds
HS wounds present with recurring nodules and abscesses, which are firm lumps and pockets of pus that may drain. These lesions can also form narrow channels under the skin called sinus tracts, connecting different affected areas. HS commonly develops in intertriginous areas, including the armpits, groin, inner thighs, under the breasts, and on the buttocks.
Inflammation plays a significant role, as the body’s immune system attacks hair follicles, leading to abscesses. This cycle of inflammation and healing can result in various types of scarring, including darkened or lightened areas, red or purple scars, indented scars, or raised, thickened scars known as keloids.
Everyday Wound Care
Consistent, gentle at-home care promotes healing. Clean the wound area daily with mild soap and warm water, avoiding harsh scrubbing. Antiseptic washes like chlorhexidine or benzoyl peroxide can reduce bacteria and new lesions. After cleansing, gently pat the area dry with a clean towel.
Dressings protect wounds and manage drainage. Non-adherent dressings or absorbent pads, such as abdominal pads or gauze, cover wounds and absorb fluid. These help prevent friction and protect from further damage. For painful areas, warm compresses (e.g., clean washcloth, steeped black tea bag) can reduce swelling, inflammation, and encourage drainage. Cold compresses may also provide relief.
Professional Treatments
Medical interventions are available for HS wounds. Topical treatments, such as clindamycin, are commonly prescribed for mild HS to treat infections, reduce inflammation, and potentially prevent new lesions. For widespread or persistent issues, oral antibiotics (e.g., doxycycline, erythromycin, clindamycin, rifampicin) can be prescribed for their anti-inflammatory properties, often for at least three months.
Biologic medications represent another class of treatment, specifically targeting inflammatory pathways in the body. Adalimumab (Humira) was the first biologic approved for HS and works by inhibiting TNF-alpha, a protein involved in inflammation. Other biologics, such as secukinumab (Cosentyx) and bimekizumab-bkzx (Bimzelx), which target interleukin-17A, have also been approved for moderate to severe HS.
Surgical options are available for persistent or severe lesions, including incision and drainage for acute abscesses, deroofing to remove the top of tunnels, and wide excision to remove larger affected areas. Wide excisions show lower recurrence rates in some cases.
Strategies for Long-Term Skin Health
Long-term strategies prevent new HS wounds and reduce flare frequency. Lifestyle factors play a significant role in managing HS. Weight management, particularly for those who are overweight, can reduce flare-ups and improve the condition. Quitting smoking is also beneficial, as studies show a reduced risk of developing HS and fewer flare-ups for those who cease smoking. Avoiding tight clothing that causes friction in affected areas can help prevent irritation and new lesions.
Stress management is important, as stress can trigger or worsen HS symptoms by promoting inflammation. Techniques such as mindfulness, meditation, and regular exercise can help reduce stress levels and support overall well-being. Identifying personal triggers, which can vary for each individual, is also a useful strategy. These triggers might include certain foods, hormonal changes, or excessive sweating, and recognizing them allows for proactive avoidance.