Hidradenitis Suppurativa

Hidradenitis suppurativa (HS), also known as inverse acne, is a chronic inflammatory condition that causes swollen, painful, deep nodules to form on the body. These bumps are often in areas that experience friction such as the armpits, groin folds, and inframammary folds. HS is characterized by boil-like nodules and abscesses that drain pus or blood and are extremely painful. HS can cause severe discomfort and patients can experience a significant psychologic impact.

What are the risk factors?

Onset of HS is usually at puberty and the condition is most active in patients between the ages of 20 and 40 years old. HS is three times more common in females than males. Risk factors include the following:

• Family history of HS
• Obesity and insulin resistance
• Cigarette smoking
• African ethnicity
• Inflammatory bowel disease, Crohn disease
• History of other skin disorders: psoriasis, acne, etc.
• Drugs such as lithium, sirolimus, biologics
• PAPA, PASH, and PAPASH syndrome
• Comorbidities: hypertension, diabetes mellitus, dyslipidaemia, thyroid disorders, arthropathies, PCOS, adverse cardiovascular outcomes

What is the treatment?

• Topical medications: Topical antibiotic solutions or gels such as clindamycin can be prescribed as treatment. Topical antibacterial washes are also recommended.
• Oral medications: Oral antibiotics such as doxycycline can be prescribed to reduce inflammation of lesions. In females, hormone blocking medications such as spironolactone can also be prescribed to reduce symptoms.
• Steroid injections: Steroid injections can be administered into painful nodules to directly reduce inflammation in a localized area and offer relief to a patient.
• Biologics: Systemic medications such as Humira can be offered to patients with severe HS that does not respond to other treatment options.
• Surgery and procedures: Recurrent, deep, painful nodules can be removed via surgery to improve outcomes for a patient with HS. An incision and drainage procedure can be performed in office for patients with an active, inflamed abscess. Laser hair removal can help some patients develop fewer boils.

What can I do on my own?

• Stop smoking if you smoke.
• Try to lose weight if you are overweight as HS is more common and more severe in patients who are overweight.
• Wear loose fitting clothing.

If you are experiencing symptoms of HS, do not hesitate to reach out to our dermatologists for an evaluation to develop the best treatment plan to improve your quality of life.