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Hidradenitis Suppurativa

Hidradenitis Suppurativa

Hidradenitis suppurativa, or acne inversa, is a condition that causes deep, painful boils or abscesses in your skin. It affects about 1 in 100 people. The abscesses grow when the deep roots of hair follicles get blocked and, in turn, clog up a specific type of neighboring sweat gland, called an apocrine gland. These sweat glands are found in areas of skin such as under the arms and in the genital and anal areas. But they may also be found on the neck, scalp, and elsewhere.

When these glands become blocked, they fill with fluid and can become infected. They then burst, and the infection spreads. This causes larger areas of swelling, infection, and abscesses that can spread through the layers of skin.

About hidradenitis suppurativa

Despite also being known as acne inversa, this condition is actually a chronic, debilitating, inflammatory skin disease. It is not a form of acne, despite the patches of inflammation and infection that may look or feel like deep acne cysts.

The boils and abscesses associated with hidradenitis suppurativa may also be confused with MRSA (methicillin-resistant Staphylococcus aureus), the bacterial skin infection resistant to many first-line antibiotics. It is not a MRSA infection, even though some people do find relief from a flare-up through antibiotic treatment. Unlike MRSA, it is not contagious. Rather, this is an ongoing condition that flares up, goes away for a while, and then comes back. Over time, you may find that the flare-ups do not go away and the skin can become significantly scarred.

Although hidradenitis suppurativa usually develops after puberty, it can still affect young adults while they are growing. Women may find that these areas of pain and swelling get worse before their period and then go away within 7 to 10 days. Sometimes pregnant women have an outbreak, which goes away after the pregnancy. This timing suggests that hormones are involved, but researchers have not yet found such a link. Occasionally children may also develop this condition before their teen years, but usually only if they are entering puberty early as well.

Not surprisingly, the condition can make life miserable. It tends to afflict young people at a time when many are particularly sensitive about their appearance. Not only is it painful, but its appearance and even the smell associated with the affected areas may also make you want to avoid socializing with friends and family or participating in activities such as group sports. Avoiding this kind of isolation is one of the important reasons to get treatment.

Symptoms

  • Painful boils in areas of skin that have apocrine glands, such as under your arms or around the groin

  • Painful, swollen lumps under the skin

  • Pus-filled, oozing boils

  • Unpleasant odor associated with boils

  • Changes in skin color around the area

Who’s at risk

Females are 3 times more likely than males to develop the skin disease. About a third of all cases appear to be genetic, linked to other family members with the condition. Other risk factors include smoking and being overweight.

Diagnosis

Your health care provider may do 1 or more of these to make a diagnosis:

  • Do a physical exam, assessing the number and location of sores and inflamed areas

  • Take a detailed history

  • Culture some fluid from the lesions

  • Order a blood test

Treatment

Treatment suggestions include:

  • Many people find some relief by using antibiotics including cephalosporins, tetracyclines, and clindamycin, either spread on the skin or taken by mouth.

  • Try to avoid doing any cutting on the lesions unless absolutely necessary, because this can lead to chronic scarring and more complicated cysts. 

  • Other medications for flare-ups include immune-suppressing medications, tumor necrosis factor-targeting medications, retinoids, and anti-androgen therapy.

  • Your health care provider may recommend removing the lesions through surgery or with a laser if less invasive treatments don’t work. Afterward, you may need reconstruction surgery, such as skin grafting and flaps to repair the affected area.

Possible complications

Complications can include the following:

  • Pain and discomfort

  • Infection

  • Social isolation and embarrassment

  • Scarring

  • Squamous cell carcinoma can develop in areas that are often affected; this is rare

Prevention and living with the condition

You might not be able to prevent hidradenitis suppurativa because the cause isn’t fully understood. But you can take steps to reduce your risk of a flare-up:

  • Lose weight or maintain a healthy weight.

  • Don’t smoke.

  • Take good care of your skin and maintain proper hygiene.

  • Follow health care provider's instructions and recommendations on medication, surgical choices, and care of your skin after treatment.

When to call your health care provider

Schedule an office visit if pain and infection occur. Early treatment can help reduce scarring and more severe complications later in life.