Hidradenitis suppurativa

Created: 03.08.2023

Updated 28.12.2023

Approved by: General Practitioner, Dr Binita Parmar 

Hidradenitis Suppurativa (HS) is a long term painful skin condition that occurs in areas of the body with sweat glands, often in the armpits or groin. This condition leads to abscesses and scarring. The disease often starts in teens and early adulthood but can appear as early as childhood in patients who are genetically predisposed. It's more common in women, affecting about 1% of people.

What is Hidradenitis Suppurativa?

Hidradenitis Suppurativa is inflammation near hair follicles in areas of the body with sweat glands, most commonly in the armpits or groin. It can also occur around the genitals, anus, or under the breasts in women. The typical presentation is the formation of tender, red nodules in the skin that can develop into abscesses. Sometimes the affected areas may form abscesses that burst and release pus. This inflammation can go deep, creating tunnel-like wounds under the skin and may leave scars.

Hidradenitis is usually a chronic condition with fluctuating intensity. The affected areas are often sensitive and painful. The oozing and pus discharge can cause a foul odour, which can be socially and personally distressing.

Who gets HS?

Hidradenitis is not an uncommon condition, affecting approximately 1% of the population. The condition often begins during puberty but can also occur at any age after puberty. Women are affected by the condition three times more frequently than men. Despite the considerable discomfort it causes, there is often a lengthy delay from when symptoms first appear to when a diagnosis is made. This delay is likely due to the stigma attached to the condition, leading many peopl to hesitate seeking help. During this period, many individuals become unable to work, and for some, the disease leads to social isolation.

Causes

The exact causes of the disease are not fully understood, but it appears hidradenitis suppurativa has a hereditary component, with a significant percentage of individuals having multiple cases in their family. It likely also has a hormonal component, and some individuals experience worsening symptoms in relation to menstruation. The condition is more common and can be more severe in individuals who smoke or are overweight.

It's also important to note that it's not caused by poor hygiene and is not contagious.

Prevention

Quitting smoking can improve blood circulation in the skin and enhance the body's healing ability, while weight reduction can reduce symptoms in overweight people. Both are recommended lifestyle changes for managing Hidradenitis Suppurativa symptoms.

Wearing loose clothing can help minimise friction on affected areas. Avoiding hair removal and shaving can help prevent further skin irritation. Avoid squeezing or putting pressure on any new nodules. For hygiene, gently clean the areas daily to manage odour and prevent infection, for example with an antiseptic such as 4% chlorhexidine wash.

Treatment

There is no definitive cure for the condition. Treatment aims to primarily reduce symptoms, and frequency of flare-ups, and prevent the progression of the disease with the formation of fistulas/tracts and scarring in the skin.

• Mild cases may be treated with topical antibiotic creams during flare-ups. Surgical treatment involving the removal of the affected skin may be considered. In cases of acute, painful abscesses, it may be necessary to open and drain them.
• For moderate cases, as well as acute infections and flare ups, oral antibiotic treatment (such as tetracyclines) is recommended. Treatment is typically required for several weeks.
• For moderate to severe cases, seeking early assessment from a specialist is beneficial. Prompt treatment can significantly lower the chances of severe complications, such as fistulas and scarring.
• In cases of persistent or severe cases, surgical treatment is considered, involving the removing areas of inflammation or wider procedures to take away the affected tissue . Surgery is particularly effective in combination with medical treatment. In severe or recurrent cases, immunosuppressive treatments may also be considered.