Hidradenitis Suppurativa is a rare disease of the skin. This article will tell you more about it.
What is Hidradenitis Suppurativa?
The American Academy of Dermatology refers to Hidradenitis Suppurativa (or HS) as “a disease that usually begins with pimple-like bumps on the skin.” However, they go on to note that these bumps generally appear in areas that are not usually prone to acne, such as in the armpit and groin areas.
The Mayo Clinic also includes other areas where skin rubs together, such as between the buttocks and under breasts. HS patients have referred to their condition using various terms, such as pimples, deep acne cysts, blackheads, boils, or folliculitis (infected or inflamed hair follicle, which looks like a large pimple with a hair in the center). Accurate diagnosis is essential for treatment and prevention, and since HS can be similar in presentation to other skin conditions it is recommended that patients see a qualified dermatologist for diagnosis.
How does it start?
The lumps that form under the skin usually start forming around puberty and sometimes start out small and relatively painless, but can grow to the size of a grape or larger and be quite painful without becoming inflamed or infected.
These lumps usually consist of a waxy substance that is white, sometimes with a hair follicle. Blackheads often appearing in pairs, or a “double barrel” pattern, are also a common presentation. A flare up occurs when a lump or blackhead (or more than one) becomes infected, and a large sore filled with pus will form.
Often these sores will rupture on their own, but will not heal well, and they can be connected by tunnels under the skin. It is important to see a dermatologist if the condition is excessively painful, appears in multiple locations, is slow to heal (taking more than 3 weeks), or is frequently recurring (returns within weeks of treatment).
Inflammation or infection can be triggered by many factors. Hormonal changes, excessive heat and perspiration, stress, and friction from constricting garments are elements that can worsen symptoms. Some patients make lifestyle changes in an effort to prevent inflammation, such as wearing loosely fitting garments or switching to an antibacterial body wash.
A warm compress or poultice can be applied to an inflamed sore, and if one has ruptured or been lanced by a medical professional it is important to keep it clean and apply antibacterial ointment, as well as keep it lightly bandaged so that it can heal.
There is currently no cure for Hidradenitis Suppurativa. Many doctors recommend preventative measures such as those already described, but in severe cases medical intervention can be necessary. Your doctor may prescribe an oral antibiotic to treat an occurring infection or a topical antibiotic in the form of cream or ointment to be applied as a preventative measure.
Corticosteroids have been used, either injected directly into a lump to reduce inflammation or in oral form, but long term use has significant side effects, including osteoporosis. Tumor Necrosis Factor (TNF)-Alpha Inhibitors such as Remicade and Humira are being studied as treatment options, but come with an increased risk of infection, heart failure, and certain cancers.
In severe or persistent cases, your doctor may choose a surgical option. In acute cases an incision can be made in an individual sore and the fluid drained. This is known as “lancing” and is meant to provide temporary relief. Patients whose sores are connected by tunnels can have a procedure done known as “de-roofing”, in which skin and other tissue is opened or removed surrounding the connections. In the most severe or recurrent cases, a full surgical removal of all affected tissues can be performed, often resulting in a skin graft to close the wound. None of these surgical treatments prevents HS from occurring in other parts of the body.
Hidradenitis Suppurativa is considered a rare condition, but if you’re experiencing any of the symptoms noted here, please consult your primary care doctor for a referral to a dermatologist.
This article is written by Vanessa. Vanessa is a Spoonie mom with three kids. She has Fibromyalgia as well as a few other conditions that range from sensory processing disorder to mental health issues. She enjoys managing a few online support communities for people with chronic illness, and helping spread awareness and compassion.