Overview

Hidradenitis Suppurativa, often called HS, is a chronic skin condition that causes painful, deep lumps under the skin. These lumps usually develop where skin rubs together, like the armpits, groin, buttocks, and under the breasts. HS happens when hair follicles become blocked and then inflamed.

While the exact cause isn't fully understood, it's thought to involve a combination of genetics, hormones, and environmental factors; it's not caused by poor hygiene. HS typically starts after puberty, most often in a person's teens or 20s, and it's more common in women. It is not contagious, so you can't catch it from someone or give it to someone else. Living with HS can be challenging and significantly impact daily comfort and emotional well-being, but understanding the condition is the first step.

Symptoms

You might experience a range of symptoms with HS, and they can vary in severity:

• Painful, pea-sized to marble-sized lumps: These are often the first sign and develop deep under the skin. They can be very tender to the touch.
• Blackheads: Often appearing in pairs or a "double-barrelled" pattern in the affected areas.
• Lumps that break open: These inflamed lumps can rupture and drain pus, which may have an odor.
• Tunnels under the skin: Over time, tracts or tunnels can form connecting the lumps under the skin.
• Scarring: Repeated flare-ups in the same area can lead to significant scarring, which can sometimes be thick and rope-like.
• Itching or burning sensation: Some people experience itching or burning in the affected areas before lumps appear.
• Reduced range of motion: In severe cases, scarring in areas like the armpits can make it difficult to move your arm freely.
• Flare-ups: Symptoms often come and go in cycles, with periods of worsening (flares) and periods of improvement. Stress or hormonal changes can sometimes trigger these flares.

Diagnosis

Diagnosing HS usually involves a dermatologist carefully examining your skin and talking with you about your symptoms and medical history. There isn't one specific blood test for HS.

Your doctor will look for the typical types of lumps and their location (armpits, groin, etc.), and ask how long you've had them and if they keep coming back. Sometimes, if a lump is draining, your doctor might take a swab of the fluid to check for any secondary bacterial infection, but this isn't to diagnose HS itself. In rare cases, a skin biopsy (where a small piece of skin is removed and looked at under a microscope) might be done to rule out other conditions.

Management & Treatment

Living with Hidradenitis Suppurativa (HS) can be challenging, both physically and emotionally. The good news is that there are effective treatments available to manage the condition, reduce flare-ups, and improve your quality of life. Finding the right approach is a journey, and we're here to guide you through it.

It's important to know that HS is a chronic condition, which means it can come and go over many years. While there isn't a cure, a consistent and personalized treatment plan can make a significant difference.

Home Care and Self-Management

Simple changes at home can play a big role in managing your HS:

• Warm Compresses: Applying a warm, moist cloth to the affected areas can help soothe the skin and encourage bumps to drain.
• Gentle Cleansing: Use an antiseptic wash to gently cleanse the affected skin. This helps to reduce bacteria and can be a good first step in your daily routine.
• Loose-Fitting Clothing: Tight clothes can rub against the skin and trigger flare-ups. Opt for loose, breathable fabrics to minimize irritation.
• Avoid Shaving: Shaving can irritate the skin in affected areas. It’s best to avoid shaving if you have an active flare-up.

Over-the-Counter (OTC) Options

For mild symptoms, you might find some relief with over-the-counter products. Pain relievers can help with discomfort. It's always a good idea to talk to a pharmacist or your doctor before starting any new OTC treatment.

When Prescription Treatments Are Needed

If home care and OTC options aren't enough, it's time to see a healthcare professional. They can offer a range of prescription treatments tailored to your specific needs.

• Topical Medications: These are creams and lotions you apply directly to your skin. Antibiotic creams can help reduce bacteria and inflammation.
• Oral Medications:
  • Antibiotics: These are often prescribed to fight infection and reduce inflammation. Sometimes, a combination of two different antibiotics is used.
  • Retinoids: These are a class of medications related to vitamin A that can help to control skin cell growth and reduce inflammation.
  • Hormone Therapy: For some women, hormonal fluctuations can trigger HS flares. Certain types of birth control pills may help to regulate these flares.
  • Biologics: For more severe HS, your doctor might recommend a type of medication called a biologic. These are powerful drugs that work by calming down your immune system.

Procedures and Surgery

In some cases, especially when HS is more advanced, your doctor might recommend a procedure to provide relief.

• Injections: Steroid injections directly into the painful bumps can quickly reduce inflammation and pain.
• Laser Therapy: This can be an effective option to remove HS bumps and is sometimes used for hair removal in affected areas to prevent new bumps from forming.
• Incision and Drainage: While this can provide temporary relief from a painful abscess, it's generally not a long-term solution.
• Surgical Removal: For persistent and painful tracts under the skin, a surgeon may remove the affected tissue.

Lifestyle Changes

Certain lifestyle adjustments can have a positive impact on your HS:

• Weight Management: If you are overweight, losing weight can significantly reduce the severity of your symptoms.
• Smoking Cessation: Quitting smoking is one of the most important things you can do to improve your HS.

What to Expect

With the right treatment plan, you can expect to see a reduction in the number and severity of your flare-ups. It can take some time to find the combination of treatments that works best for you, so regular follow-up with your dermatologist is key.

If you feel like your treatment isn't working, don't lose hope. There are many options available, and your doctor can work with you to find a different approach. Living with HS has its ups and downs, but with the right care and support, you can lead a full and active life.

Duration & Outlook

HS is generally a chronic condition, which means it can last for many years, often with periods of flare-ups and remission (times when symptoms improve). For some people, symptoms may lessen with age, particularly after menopause for women, but for others, it can be a lifelong concern.

The outlook for HS varies greatly from person to person. Some may have mild, infrequent flare-ups, while others experience more severe and persistent symptoms. While there isn't a cure, managing the condition can help reduce the frequency and severity of flares and improve quality of life. Warning signs for complications include widespread infection (fever, chills, spreading redness), rapidly worsening pain, or significant new scarring that limits movement. If you notice these, it's important to seek medical attention.

Prevention

While you can't completely prevent HS if you're predisposed to it, there are steps you can take that may help reduce the frequency or severity of flare-ups. It’s about managing potential contributing factors.

Avoiding known triggers is key. This might include wearing loose-fitting clothing to reduce friction in affected areas, maintaining a healthy weight, and quitting smoking, as smoking is a significant risk factor. Good skin hygiene is always important, but remember, HS is not caused by being unclean. Gentle cleansing of affected areas can be helpful.

Causes & Triggers

The exact cause of Hidradenitis Suppurativa is complex and not fully understood, but it's believed to start with the blockage of hair follicles. This blockage leads to inflammation, swelling, and eventually, the rupture of the follicle, causing the painful lumps. It is not an infection itself, nor is it caused by poor hygiene.

Common triggers that can worsen HS or lead to flare-ups include:

• Hormonal changes: Many people notice flare-ups related to their menstrual cycle.
• Friction and sweating: Tight clothing or activities that cause skin to rub together can aggravate symptoms.
• Smoking: Tobacco use is strongly linked to HS and can make it worse.
• Weight: Being overweight can increase skin friction and inflammation.
• Stress: Emotional stress can sometimes trigger flare-ups.

HS is more likely to develop in individuals with a family history of the condition, suggesting a genetic component. It often begins after puberty and is more common in women. Certain other conditions, like inflammatory bowel disease, are sometimes seen alongside HS.

When to see a doctor

It's important to see a doctor, preferably a dermatologist, if you suspect you have HS. Early diagnosis and management can make a big difference.

You should look for these signs:

• Painful lumps that keep coming back in areas like your armpits, groin, buttocks, or under your breasts.
• Lumps that drain pus or blood.
• Sores that heal very slowly or leave scars.
• Tunnels forming under your skin.
• If your skin condition is causing you significant pain, distress, or affecting your daily life.

A dermatologist is specially trained to diagnose skin conditions like HS and can help you understand your condition. Don't hesitate to reach out if you're concerned; you don't have to manage this alone.

Frequently Asked Questions (FAQs):

• Is HS contagious? No, HS is not contagious. You cannot catch it from someone else, and you cannot pass it on to others through skin contact or sharing items.
• Is HS caused by bad hygiene? Absolutely not. HS is an inflammatory condition related to hair follicles, not cleanliness. While gentle skin care is important, HS is not a result of being unclean.
• Can HS be cured? Currently, there is no known cure for HS, but there are ways to manage the symptoms, reduce flare-ups, and improve your quality of life. It's a chronic condition that requires ongoing care.
• Does diet affect HS? Some people find that certain foods may trigger their HS or make it worse, but this can be very individual. While research is ongoing, some studies suggest avoiding dairy or sugary foods might help some individuals. It's best to discuss any dietary changes with your doctor.
• Will HS go away on its own? For some people, HS symptoms may improve or become less frequent over time, especially after menopause for women. However, for many, it's a long-term condition that requires management. It's unlikely to completely disappear without any form of care or lifestyle adjustments if you are prone to it.

References

• American Academy of Dermatology. (n.d.). Hidradenitis suppurativa: Diagnosis and treatment. Retrieved from https://www.aad.org/public/diseases/a-z/hidradenitis-suppurativa-treatment
• Cleveland Clinic. (2022, July 18). Hidradenitis Suppurativa (Acne Inversa): Symptoms & Treatments. Retrieved from https://my.clevelandclinic.org/health/diseases/17716-hidradenitis-suppurativa
• Mayo Clinic. (2023, March 14). Hidradenitis suppurativa. Retrieved from https://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/diagnosis-treatment/drc-20352311
• National Center for Biotechnology Information. (2023, August 8). Hidradenitis Suppurativa. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK534867/
• NHS. (2022, November 29). Hidradenitis suppurativa (HS). Retrieved from https://www.nhs.uk/conditions/hidradenitis-suppurativa/