Hidradenitis suppurativa (HS) is a chronic, long-term skin condition that affects the sweat glands and hair follicles of the body. It is characterized by painful lumps or nodules filled with pus that can form in areas such as the armpits, groin, inner thighs, buttocks, and under breasts. HS often goes undiagnosed for years because many people are unaware of it or mistake its symptoms for acne. Left untreated, these bumps may become larger and more frequent resulting in significant discomfort and decreased quality of life. Fortunately, there are effective treatments available today to help manage this disabling condition.
Here, we’ll take an in-depth look at hidradenitis suppurativa, what causes it, its symptoms, treatments, and more.
History and Definition
Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition that has been recognized for centuries under various names, including acne inversa, Verneuil’s disease, and apocrine acne. The first written description of the disease dates back to the 19th century when French surgeon Aristide Verneuil identified a cluster of painful, recurrent abscesses in the axilla (armpit) and perineal areas of his patients.
HS was initially believed to be a form of acne, but as more research was conducted, it became clear that it is a distinct disorder. In the 1980s, a consensus definition for HS was established by a group of dermatologists and surgeons, which defined HS as “a chronic, suppurative, and cicatricial disease of the apocrine gland-bearing areas of the body.”
Since then, HS has gained more recognition and attention as a significant medical issue. However, the condition is still often misdiagnosed or underdiagnosed due to its variable presentation and lack of awareness among healthcare providers.
In recent years, advancements in the understanding of the pathogenesis of HS have led to the development of new treatments and management strategies. Despite this progress, there is still much to be learned about this complex condition, and ongoing research efforts are focused on improving our understanding of HS and its underlying mechanisms.
Symptoms
The symptoms of hidradenitis suppurativa (HS) can vary from person to person, but the condition is typically characterized by the following:
- Painful, recurrent abscesses or nodules: These can develop in areas of the body with high concentrations of apocrine sweat glands, such as the armpits, groin, buttocks, and breasts. These abscesses can be tender, swollen, and may rupture and drain pus.
- Inflammation: The affected areas may be red, warm to the touch, and swollen.
- Scarring: Over time, the abscesses and nodules can lead to the formation of tunnels or tracts under the skin, which can result in scarring and thickened, raised skin in the affected areas.
- Restricted movement: In severe cases, the scarring and inflammation can lead to limited movement in the affected area, which can affect daily activities and quality of life.
- Secondary infections: Due to the open wounds and constant drainage, HS can increase the risk of developing secondary infections, such as cellulitis or abscesses.
- Malodor: The drainage from the affected areas can have a strong, unpleasant odor.
The symptoms of HS can vary in severity, and some people may only experience mild symptoms, while others may experience more severe symptoms that significantly impact their daily life. It is important to seek medical attention if you suspect you may have HS to receive an accurate diagnosis and appropriate treatment.
Causes
The exact causes of hidradenitis suppurativa (HS) are not well understood, but it is thought to be a result of a combination of genetic, hormonal, and environmental factors.
The exact mechanisms underlying the development of HS are still being researched, and ongoing studies are aimed at improving our understanding of this complex condition.
Diagnosis
Diagnosing hidradenitis suppurativa (HS) can be challenging, as the condition can present differently in different individuals and can be mistaken for other skin conditions. However, there are several methods that healthcare providers may use to diagnose HS, including:
- Physical examination: A healthcare provider may conduct a physical exam to assess the location, size, and appearance of any abscesses, nodules, or scarring. They may also ask about the patient’s medical history, including any family history of HS.
- Imaging tests: In some cases, a healthcare provider may order imaging tests, such as ultrasound, MRI, or CT scans, to assess the extent of the disease and to rule out other conditions.
- Biopsy: A biopsy may be performed to confirm the diagnosis of HS. During a biopsy, a small sample of tissue from an affected area is removed and examined under a microscope to look for characteristic changes consistent with HS.
- Diagnostic criteria: The International Hidradenitis Suppurativa Foundation has established clinical diagnostic criteria for HS, which include the presence of typical lesions in characteristic locations, a chronic or relapsing course, and the exclusion of other conditions that can mimic HS.
Seek medical attention if you suspect you may have HS, as early diagnosis and treatment can help manage symptoms and prevent complications. A dermatologist or plastic surgeon with experience in diagnosing and treating HS can provide an accurate diagnosis and recommend appropriate treatment options.
Treatment
Treatment for hidradenitis suppurativa (HS) depends on the severity of the disease and may include both non-surgical and surgical options.
Non Surgical
- Topical and oral medications: Antibiotics and anti-inflammatory medications may be prescribed to reduce inflammation, prevent infection, and manage pain.
- Intralesional corticosteroid injections: These injections may be given directly into the affected area to help reduce inflammation and promote healing.
- Topical or systemic immunomodulatory agents: These medications work to modify the immune system and may be used in severe or refractory cases.
- Biologics: Biologics are a type of medication that works by targeting specific proteins in the immune system. They may be used in severe cases of HS that have not responded to other treatments.
Surgical
- Incision and drainage: For larger abscesses or areas of significant inflammation, a healthcare provider may perform an incision and drainage procedure to drain pus and relieve pressure.
- Wide local excision: This surgical procedure involves removing the affected tissue and surrounding skin to prevent recurrent outbreaks. This may be considered in severe or recurrent cases of HS.
- Skin grafting: In some cases, skin grafting may be needed to cover large areas of skin that have been removed during surgical procedures.
After treatment for HS, patients may experience some degree of scarring or changes in skin texture in the affected area. It is important to follow up with a healthcare provider to monitor for any signs of recurrence or complications. Lifestyle modifications, such as maintaining a healthy weight, avoiding tobacco use, and practicing good hygiene, may also be recommended to help manage symptoms and prevent recurrences.
Risk Factors
Several risk factors may increase the likelihood of developing hidradenitis suppurativa (HS), including:
- Gender: HS affects more women than men.
- Age: HS often develops in young adulthood, with the highest incidence in individuals aged 18-29.
- Genetics: There is a genetic component to HS, and it tends to run in families.
- Hormonal imbalances: HS may be associated with hormonal imbalances, particularly with androgens, which are male hormones that are also present in women.
- Obesity: Being overweight or obese can increase the risk of developing HS, as it may contribute to increased friction and sweating in the affected areas.
- Smoking: Smoking is a risk factor for HS, and may also make symptoms worse.
- Personal hygiene: Poor personal hygiene may contribute to the development of HS, particularly in areas with skin folds or that are prone to sweating.
- Environmental factors: Exposure to certain chemicals or toxins may increase the risk of developing HS, although more research is needed in this area.
Not everyone who has these risk factors will develop HS, and having one or more risk factors does not necessarily mean that someone will develop HS. The exact causes and risk factors for HS are still being studied, and ongoing research is aimed at improving our understanding of this complex condition.
Complications
Hidradenitis suppurativa (HS) can lead to several complications, some of which may be serious. These complications may include:
- Abscesses: HS can cause abscesses, which are collections of pus that can be painful and may require drainage.
- Fistulas: In severe cases, HS may cause tunnels to form beneath the skin, known as fistulas. These can become infected and may require surgical intervention.
- Scarring: HS can cause scarring in affected areas, which can be unsightly and may cause discomfort.
- Reduced mobility: HS in areas such as the armpits or groin can be painful and may limit mobility.
- Decreased quality of life: HS can be a chronic and debilitating condition that can negatively impact the quality of life. This may include difficulty with activities of daily living, work, and social interactions.
- Depression and anxiety: Living with a chronic condition like HS can be emotionally challenging and may lead to depression and anxiety.
- Squamous cell carcinoma: In rare cases, HS may progress to squamous cell carcinoma, a type of skin cancer.
Early diagnosis and treatment can help manage symptoms and prevent complications. An experienced dermatologist or plastic surgeon can diagnose and treat HS accurately, and recommend the appropriate treatment. An experienced dermatologist or plastic surgeon can diagnose and treat HS accurately, and recommend the appropriate treatment.
When to See a Doctor
If you are experiencing symptoms of hidradenitis suppurativa (HS), it is important to see a doctor, plastic surgeon, or dermatologist for an accurate diagnosis and appropriate treatment. Some signs that you should see a healthcare provider include:
- Persistent lumps, bumps, or boils in the skin: If you have areas of your skin that are consistently inflamed, and painful, or have developed a lump or boil that does not go away, you should see a healthcare provider.
- Painful, swollen areas of skin: If you have areas of skin that are painful or swollen, particularly in the groin, armpits, or buttocks, you should seek medical attention.
- Recurrent infections or abscesses: If you have frequent infections or abscesses that are causing discomfort or difficulty with daily activities, you should see a healthcare provider.
- Foul-smelling drainage: If you notice an unusual odor or drainage from an affected area, this may be a sign of infection and should be evaluated by a healthcare provider.
- Changes in skin texture or appearance: If you notice changes in the texture or appearance of your skin in affected areas, such as scarring, thickening, or discoloration, you should see a healthcare provider.
- Emotional distress: If your HS is causing emotional distress or negatively impacting your quality of life, it is important to seek medical attention for appropriate treatment and support.
In general, if you have concerns about your skin or are experiencing discomfort or pain, it is always a good idea to seek the advice of a healthcare provider.
Step-by-Step Guide to Carpal Tunnel Syndrome Treatment
Here is a step-by-step guide to the treatment of hidradenitis suppurativa:
Consultation
The first step in treating HS is to consult with a healthcare provider or dermatologist. The healthcare provider will examine the affected areas and may order tests, such as a skin biopsy, to confirm the diagnosis. The provider may also ask questions about your medical history and any other conditions you have to determine the best treatment options.
Treatment Plan
Once the diagnosis of HS is confirmed, the healthcare provider will work with you to develop a treatment plan that is tailored to your individual needs. The treatment plan may include both medical and lifestyle changes.
- Medical treatments: Medical treatments for HS may include topical or oral antibiotics to control bacterial infections, corticosteroids to reduce inflammation, or other medications to manage symptoms. In some cases, biologic medications that target specific components of the immune system may be prescribed. In severe cases, surgical intervention may be necessary.
- Lifestyle changes: Lifestyle changes may also be recommended to manage HS symptoms. These may include weight loss, smoking cessation, and improving personal hygiene. Wearing loose-fitting clothing and avoiding tight clothing that can rub against affected areas may also be helpful.
After-Treatment Care
After treatment, it is important to continue to monitor the affected areas and follow any instructions provided by the healthcare provider. This may include ongoing medication, follow-up appointments, or self-care measures to manage symptoms.
Living with HS can be challenging, and it is important to have support and access to resources. Support groups and online communities can provide a forum for individuals with HS to connect and share information and experiences. It may also be helpful to work with a mental health professional to manage the emotional impact of HS.
Conclusion
Hidradenitis suppurativa (HS) is an inflammatory skin condition that can cause significant physical and emotional distress for those affected by it. Although there is no cure for HS, there are treatment options available to help manage the symptoms and reduce flares. These treatments include topical medications, antibiotics, corticosteroids, laser therapy, and biologic agents. In some cases, more invasive surgical approaches may also be recommended. It’s important to remember that everyone’s experience with HS is unique; what works best for one person might not necessarily work best for another. That said, speaking with a qualified healthcare professional about the available treatment options can help you find the right approach to managing your symptoms and improving your quality of life.
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Dr. Colin Hong is a highly experienced plastic surgeon in Toronto, bringing over 35 years of expertise in cosmetic, plastic, and reconstructive surgeries. His prices are some of the most affordable in the area, making his services accessible to a wider range of patients.
To schedule a consultation with Dr. Hong, please contact our office at (416) 222-6986 or email us at info@drcolinhong.com. In your message, kindly provide us with your full name, email, and phone number, so we can get back to you promptly. To book an appointment for hidradenitis suppurativa treatment with Dr. Colin Hong, please ensure that you have obtained a referral from your family doctor.
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