Hidradenitis suppurativa (HI-drad-en-I-tis sup-per-ah-TEE-vah or HS) is a chronic condition of painful bumps and draining sores of the skin. It usually affects the skin folds, such as the underarms, buttock crease, under the breasts and groin area. It is sometimes called “acne inversa,” although it is different from acne. HS is 2-4 times more common in females. It is also more common in African Americans. Onset is generally after puberty and most common between 20-24 years of age.
Unfortunately, HS is often misdiagnosed. In one study, the delay from onset of symptoms to diagnosis was 7 years and 5 providers were seen before the correct diagnosis was made.
The exact cause of HS is not known. It is not caused by poor hygiene. Individual lesions of HS look like an infection, but research suggests they are not. However, the bumps and open areas often get secondarily infected.
The lesions of HS usually start as a single inflamed, painful, raised lump (nodule). The nodule either slowly disappears (between 10 and 30 days) or opens up, draining pus. Eventually, healing occurs but a scar may remain.
The individual bumps and sores may last for weeks or months. They may keep coming back. In most cases, HS is considered a chronic, or long-lasting condition. Each patient is different, and the bumps may get better or worse over time.
Some patients find diluted bleach baths (swimming pool baths) helpful. Add 1/4 cup of bleach to a half tub of water. Soak for 5-15 minutes, 2-3 times a week.
Topical antibiotics like clindamycin are often prescribed. Apply to affected areas 2/day.
Antibiotics (e.g. doxycycline) can be very helpful. They are usually prescribed over several months.
Girls and women with HS may notice that their HS changes with their menstrual cycle. Some forms of birth control can help regulate the hormones that make HS worse. A pill called spironolactone can block the hormones that make HS worse. Your doctor can discuss the risks and benefits of hormonal therapy with you, but these medicines are generally considered quite safe for girls and women with HS. (As a general comment for females with HS in the groin, tampons may be better than sanitary pads as they minimize moisture to that area.)
Laser hair removal can be dramatically helpful in some patients.
More severe cases of HS that have not responded to other treatments may benefit from a biologic medication (a "shot" given regularly). Options include bimekizumab, secukinumab and adalimumab.
Surgery can be very beneficial for extensive HS, or HS resistant to medical intervention.
If you are pregnant, planning pregnancy, or breastfeeding, please discuss this with your doctor as your medication plan may need to be adjusted.