Hidradenitis suppurativa (HS) is a chronic inflammatory condition affecting areas of the body with apocrine glands (particular types of sweat glands). The main areas affected are the armpits, groin and under the breasts. HS may start with pimples and progress to form nodules (lumps) and boils (abscesses) under the skin. When these become connected together, tunnels under the skin (sinus tracts) may form. Scarring can occur when these tracts try to heal.
HS can affect men, but is more common amongst women and it tends to start after puberty. The cause is not completely clear but risk factors for the development of HS include:
- Hormone levels. We do not know exactly how hormones affect HS, but androgen levels (testosterone) rise after puberty, when people are more susceptible to this condition.
- Other conditions such as acne and polycystic ovary syndrome (PCOS).
Initially it was thought that the central problem was the sweat gland itself, but it is now thought that the process starts from blockage of the hair follicles, causing inflammation, bacterial overgrowth and often secondary infection.
Treatment at The Skin Hospital
HS is difficult to treat, however there are many different treatments that can be effective.
- General measures: cessation of smoking and weight loss can be very helpful in improving symptoms.
- Topical treatments: washing with a mild antiseptic wash (e.g. chlorhexidine) can help reduce the bacterial load.
- Oral treatments (1): some treatments are similar to those used in acne.
- Tetracycline antibiotics (taken over months) can work by reducing inflammation.
- Other oral antibiotics may be required to treat acute infection from problem abscesses for shorter durations.
- The oral contraceptive pill (anti-androgen type) can be helpful in women.
- Retinoids (which are derived from vitamin A, e.g. isotretinoin and acitretin) can be effective. These cannot be used in pregnant women or those planning a pregnancy.
- Oral treatments (2): immunomodulators
- If the condition is resistant to other treatments, tablet medications that dampen down the immune system (such as methotrexate and ciclosporin) can be used.
- Other treatments:
- Clinical trials are being undertaken to assess the effectiveness of biologic agents (such as adalimumab and infliximab) in HS.
- Surgery can also be considered in some cases. Incision and drainage of specific abscesses is sometimes necessary. Excision of the affected skin in some areas can be useful, but generally does not produce a cure. This condition can be psychologically distressing and greatly affect quality of life due to pain and the physical appearance of the skin affected by the disease, psychological support is important in the management of this condition.
Dermatologists at The Skin Hospital to consult about hidradenitis suppurativa:
Further information about HS can be obtained from the following trusted sites:
Psychological support is important in HS; here is a link for a patient support group, which might be helpful for patients and families supporting those with HS: