What is Hidradenitis Suppurativa? Symptoms, Causes, & Treatment

Hidradenitis suppurativa is a chronic skin condition that causes painful bumps and abscesses in areas where skin rubs together. You might know it better as HS, and it typically affects places like your armpits, groin, buttocks, and under the breasts.

This condition happens when hair follicles become blocked and inflamed, leading to deep, tender lumps that can break open and drain. While HS can be challenging to live with, understanding what's happening and knowing your treatment options can help you manage it effectively.

What is Hidradenitis Suppurativa?

Hidradenitis suppurativa is an inflammatory skin disease that creates painful, recurring bumps in your body's fold areas. These areas include places where your skin naturally touches skin, creating warm, moist environments.

The condition starts when hair follicles get clogged with dead skin cells and oils. Unlike regular acne, HS goes much deeper into your skin and affects the apocrine glands, which are sweat glands found in areas with coarse hair.

HS is not contagious, so you can't catch it from someone else or spread it to others. It's also not caused by poor hygiene, despite what some people might think.

What are the symptoms of Hidradenitis Suppurativa?

The most common early sign is small, tender bumps that feel like peas under your skin. These bumps often appear in areas where your skin rubs together during daily activities.

Here are the main symptoms you might experience:

• Painful, red bumps that start small but can grow larger
• Deep, pus-filled lumps that may break open and drain
• Blackheads that appear in pairs or groups
• Thick, rope-like scars that connect different affected areas
• Tunnels under your skin that link bumps together
• Persistent drainage with an unpleasant odor
• Itching and burning sensations in affected areas

The symptoms often come and go in cycles. You might have flare-ups where new bumps appear, followed by periods when your skin feels better.

Some people with HS also experience fever, fatigue, and general feelings of being unwell during severe flare-ups. These whole-body symptoms happen because your immune system is working hard to fight the inflammation.

What are the types of Hidradenitis Suppurativa?

Doctors classify HS into three stages based on how severe your symptoms are. This classification system is called the Hurley staging system, and it helps your healthcare provider plan the best treatment approach.

Stage 1 (Mild): You have single or multiple bumps without any scarring or tunnel formation. The bumps might drain, but they don't connect to each other under your skin.

Stage 2 (Moderate): You have recurring bumps with some tunnel formation and scarring. The affected areas might have several bumps that are connected by tunnels under your skin.

Stage 3 (Severe): You have widespread bumps, extensive tunnel networks, and significant scarring across large areas. This stage often involves multiple connected areas and can significantly impact your daily life.

Most people start with Stage 1 symptoms, but the condition can progress over time if left untreated. Early treatment can help prevent progression to more severe stages.

What causes Hidradenitis Suppurativa?

The exact cause of HS isn't completely understood, but it starts with blocked hair follicles in areas where you have apocrine sweat glands. When these follicles get clogged, bacteria can grow and cause inflammation.

Several factors work together to trigger HS:

• Genetics - about one-third of people with HS have family members with the condition
• Hormonal changes, especially during puberty, menstruation, or pregnancy
• Immune system dysfunction that causes excessive inflammation
• Friction from tight clothing or skin rubbing against skin
• Smoking, which can worsen inflammation and slow healing
• Obesity, which increases skin friction and hormonal changes

It's important to know that HS is not caused by poor hygiene or being "dirty." Even people with excellent hygiene habits can develop this condition.

Some rare genetic mutations can also cause HS. These involve genes that control how your immune system responds to inflammation, but this accounts for only a small percentage of cases.

When to see a doctor for Hidradenitis Suppurativa?

You should see a healthcare provider if you have recurring painful bumps in your armpit, groin, buttocks, or breast areas. Early treatment can prevent the condition from getting worse and reduce your risk of complications.

Seek medical attention right away if you experience:

• Fever along with your skin symptoms
• Red streaks extending from the affected area
• Bumps that are extremely painful or growing rapidly
• Signs of widespread infection like chills or feeling very unwell
• Difficulty moving due to pain or swelling

Don't wait if your symptoms are affecting your quality of life, work, or relationships. Many people with HS delay seeking treatment because they feel embarrassed, but dermatologists are very familiar with this condition.

If you've been treating what you think is regular acne or boils without improvement, it's worth getting a professional opinion. HS requires different treatment approaches than other skin conditions.

What are the risk factors for Hidradenitis Suppurativa?

Several factors can increase your likelihood of developing HS. Understanding these risk factors can help you and your doctor assess your situation and plan preventive strategies.

The most common risk factors include:

• Age - HS typically starts after puberty, most commonly in your 20s and 30s
• Gender - women are about three times more likely to develop HS than men
• Family history - having relatives with HS increases your risk significantly
• Smoking - tobacco use doubles your risk and makes symptoms worse
• Obesity - excess weight increases friction and hormonal changes
• Other autoimmune conditions like inflammatory bowel disease

Some people also have higher risk due to certain medications or medical conditions that affect their immune system. Hormonal conditions like polycystic ovary syndrome (PCOS) can also increase your risk.

While you can't change factors like your genetics or gender, you can work on modifiable risk factors. Maintaining a healthy weight and avoiding smoking can help reduce your risk or improve your symptoms if you already have HS.

What are the possible complications of Hidradenitis Suppurativa?

Without proper treatment, HS can lead to several complications that affect both your physical health and quality of life. The good news is that early treatment can prevent most of these problems.

Physical complications can include:

• Permanent scarring and skin thickening in affected areas
• Restricted movement due to scar tissue formation
• Chronic pain that interferes with daily activities
• Secondary bacterial infections requiring antibiotic treatment
• Lymphatic drainage problems causing swelling
• Kidney problems from chronic inflammation (rare but serious)

HS can also significantly impact your emotional well-being. Many people experience depression, anxiety, and social isolation due to pain, odor, and appearance concerns.

In very rare cases, long-standing HS can increase the risk of a type of skin cancer called squamous cell carcinoma. This typically only happens in areas with severe, chronic inflammation that has been present for many years.

The key to preventing complications is working with your healthcare team to manage your condition effectively. With proper treatment, most people with HS can live full, active lives.

How can Hidradenitis Suppurativa be prevented?

While you can't completely prevent HS if you're genetically predisposed to it, you can take steps to reduce your risk of flare-ups and slow the condition's progression.

Lifestyle changes that may help include:

• Maintaining a healthy weight to reduce skin friction
• Quitting smoking, which significantly improves outcomes
• Wearing loose, breathable clothing made from natural fibers
• Using gentle, fragrance-free soaps and avoiding harsh scrubbing
• Managing stress through relaxation techniques or counseling
• Following an anti-inflammatory diet rich in fruits and vegetables

Some people find that certain foods trigger their flare-ups. Common triggers include dairy products, foods high in sugar, and foods from the nightshade family like tomatoes and peppers.

Keep a symptom diary to identify your personal triggers. This can help you make informed decisions about lifestyle changes that might benefit your specific situation.

How is Hidradenitis Suppurativa diagnosed?

Diagnosing HS primarily relies on your doctor's clinical examination and your medical history. There isn't a specific blood test or imaging study that definitively diagnoses HS.

Your doctor will look for the characteristic pattern of bumps, scars, and tunnels in typical body areas. They'll ask about when your symptoms started, how often you have flare-ups, and whether anyone in your family has similar problems.

The diagnostic criteria include having typical bumps in characteristic locations at least twice within six months. Your doctor might also perform a bacterial culture if they suspect a secondary infection.

In some cases, your doctor might recommend a small skin biopsy to rule out other conditions. This is more common when the diagnosis isn't clear or when symptoms don't respond to typical treatments.

Getting an accurate diagnosis is important because HS can be confused with other conditions like regular boils, pilonidal cysts, or Crohn's disease complications. A dermatologist who specializes in inflammatory skin conditions can provide the most accurate diagnosis.

What is the treatment for Hidradenitis Suppurativa?

Treatment for HS focuses on reducing inflammation, preventing new lesions, and managing pain. Your treatment plan will depend on how severe your condition is and which areas of your body are affected.

For mild HS (Stage 1), treatments often include:

• Topical antibiotics applied directly to affected areas
• Warm compresses to reduce pain and encourage drainage
• Anti-inflammatory medications like ibuprofen for pain relief
• Antiseptic washes to prevent secondary infections

For moderate to severe HS, your doctor might recommend:

• Oral antibiotics for longer periods to control inflammation
• Hormonal treatments, especially for women whose symptoms worsen with menstrual cycles
• Biologic medications that target specific parts of your immune system
• Steroid injections directly into large, painful bumps
• Surgical procedures to remove affected tissue or drain large abscesses

Newer biologic treatments like adalimumab have shown excellent results for many people with moderate to severe HS. These medications work by blocking specific inflammatory signals in your immune system.

Surgery might be needed for severe cases, especially when you have extensive tunnel formation or scarring. Surgical options range from simple drainage procedures to more extensive tissue removal and reconstruction.

How to manage Hidradenitis Suppurativa at home?

Home management plays a crucial role in controlling HS symptoms and preventing flare-ups. These strategies work best when used alongside your prescribed medical treatments.

Daily care routines that can help include:

• Gentle cleansing with antibacterial soap, avoiding harsh scrubbing
• Applying warm, moist compresses to painful areas for 10-15 minutes
• Using loose, breathable clothing to reduce friction
• Keeping affected areas dry and well-ventilated when possible
• Avoiding tight belts, straps, or clothing that rubs against affected areas

Pain management at home can include over-the-counter anti-inflammatory medications like ibuprofen or naproxen. Always follow package directions and check with your doctor about long-term use.

Some people find relief from natural approaches like turmeric supplements, zinc, or tea tree oil applications. While these aren't proven treatments, they might provide additional comfort when used safely alongside medical care.

Stress management is also important since stress can trigger flare-ups. Consider relaxation techniques, regular exercise that doesn't irritate your skin, or counseling to help cope with the emotional aspects of living with HS.

How should you prepare for your doctor appointment?

Preparing for your doctor visit can help you get the most effective care and ensure all your concerns are addressed. Good preparation leads to better treatment outcomes.

Before your appointment, make a list of:

• All your symptoms, including when they started and how often they occur
• All medications and supplements you're currently taking
• Questions you want to ask about diagnosis, treatment options, or lifestyle changes
• Any family history of similar skin conditions
• Factors that seem to make your symptoms better or worse

Consider keeping a symptom diary for a few weeks before your appointment. Note when flare-ups occur, what you were doing, what you ate, and your stress levels.

Don't feel embarrassed about discussing your symptoms openly. Your doctor needs complete information to provide the best care, and they've seen these conditions many times before.

Bring a list of any treatments you've already tried, including over-the-counter products, home remedies, or medications prescribed by other doctors. This helps avoid repeating ineffective treatments.

What's the key takeaway about Hidradenitis Suppurativa?

Hidradenitis suppurativa is a manageable chronic condition that affects millions of people worldwide. While it can be challenging to live with, effective treatments are available that can significantly improve your quality of life.

The most important thing to remember is that early treatment makes a real difference. If you suspect you might have HS, don't wait to seek medical attention. Getting proper diagnosis and treatment early can prevent the condition from progressing to more severe stages.

You're not alone in dealing with this condition, and it's not your fault. HS is a legitimate medical condition that requires proper medical care, not something you can fix with better hygiene or willpower alone.

With the right combination of medical treatment, lifestyle changes, and self-care, most people with HS can manage their symptoms effectively and maintain active, fulfilling lives.