Images of Hidradenitis Suppurativa
Hidradenitis suppurativa is a chronic skin condition characterized by blockage of the sweat glands and subsequent inflammation and infection of the deeper skin structures. In people who are prone to hidradenitis suppurativa, the sweat glands of the armpit, belly, buttocks, and/or groin become clogged, causing large, tender red bumps to grow in these areas. The bumps represent inflammation, and over time these will become infected with bacteria; multiple bumps can grow together under the skin into large, painful cysts. These cysts can reach the surface of the skin and drain pus. The cycle of plugging, enlargement, and draining will eventually lead to scarring of the skin.
There is no cure for hidradenitis suppurativa, but your doctor can help you develop a strategy for treating existing lesions and preventing new ones.
Who's at risk?
Anyone of any race can develop hidradenitis suppurativa; it usually becomes apparent after puberty, and once it is present, it usually continues into adult life. It is more common in women and is associated with fluctuating hormone levels (such as around puberty and pregnancy), obesity, and smoking. Hair removal from shaving or using depilatories, deodorants, and irritation from anything rubbing against the affected area can worsen the condition. The psychological effects of having any chronic, painful skin condition are often more damaging than the actual skin condition.
Signs and Symptoms
The groin and armpits have high concentrations of sweat glands, which is why these areas are most severely affected by hidradenitis suppurativa. There may also be lesions between the buttocks or under the breasts due to the friction from skin rubbing together, which is why people who are obese are more predisposed to this disease.
The lesions of hidradenitis suppurativa are firm tender, red bumps with extensive scar and sinus tracking under the surface of the skin. Often, you will see a pair of blackheads within one lesion, and the lesions may drain pus. Hidradenitis suppurativa lesions are rarely seen on the trunk of the body or on the scalp or legs.
Some people may experience only one or few lesions, while others may have severe disease, affecting many areas. Increasing hormones and excessive perspiration can cause more lesions.
Make sure to wash any red, draining area(s) of hidradenitis suppurativa with an antibacterial soap, and then apply antibiotic ointment and clean bandages. If there is a large amount of drainage, change the gauze pads and dressings often. Warm compresses and ibuprofen can help reduce the swelling. Avoid tight-fitting clothing to prevent further irritation.
Weight loss may decrease lesions by decreasing skin folds and, thus, friction on the skin. Smoking should be avoided.
When to Seek Medical Care
Some cases of hidradenitis suppurativa can be treated with self-care measures. Healing of individual lesions takes about 1–2 weeks. Make sure to seek medical care if you are not able to control the pain with ibuprofen and warm compresses. Medical treatment may be necessary if the condition appears in multiple areas or continues to come back (recur). If there is redness, excessive pain, excessive drainage, red streaking, you have a fever, or there are other factors that may indicate there is an infection, see your doctor. If you have been given antibiotics and the area does not improve within a few days, return your doctor.
Treatments Your Physician May Prescribe
Your doctor may prescribe a topical antibiotic solution for mild areas or a long course of oral antibiotics to treat more severe areas. Your doctor may also send drainage for laboratory analysis to make sure that you are on the appropriate antibiotics. You may be given an injection of steroids into the deep, painful hidradenitis suppurativa lesions. If excessive hormones are thought to be the problem in a woman, she may be prescribed hormonal therapy. Oral tretinoin, used in severe acne, may be used to treat plugged sweat glands and keep them from plugging in the future. Steroids and immunosuppressive medications may be used in severe cases.
Surgical removal is often the ideal treatment for severe cases of hidradenitis suppurativa that continue to come back.
Bolognia JL, Jorizzo JL, Rapini RP, eds. Dermatology. Vol. 1. 2nd ed. St. Louis, MO: Mosby; 2008:528-529.
Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, eds. Fitzpatrick's Dermatology in General Medicine. Vol 1. 7th ed. New York, NY: McGraw-Hill; 2008:734-738.