What Is Hidradenitis Suppurativa, and How Is It Treated?

What Is Hidradenitis Suppurativa?

Hidradenitis suppurativa (HS) is a long-lasting skin condition that causes painful, inflamed lumps, cysts, and skin tunnels — often near your sweat glands. HS is likely caused by an overactive immune response to clogged, broken hair follicles. If you have HS, you understand how hard day-to-day life can be managing the painful lumps that can break open, heal, and form again. But newer treatments and lifestyle changes can bring relief and lower your risk for flareups. Learn what causes hidradenitis suppurativa bumps, how it's treated, and get tips on how to live your life to the fullest with HS.

How common is hidradenitis suppurativa?

It's fairly common; about 1 to 4 in 100 people have hidradenitis suppurativa. In the U.S., HS is more common in African American women between 30 and 39 years of age.

What Causes Hidradenitis Suppurativa?

Doctors think your immune system can over react to injured hair follicles and cause hidradenitis suppurativa. With HS, the bumps form after your hair follicle makes too many cells that clog and burst the root open. Friction near the area can also trigger pockets form under your skin, which fill with pus. When they break open, they can smell bad, leave scars, and sometimes get infected.

Who's at risk for hidradenitis suppurativa?

HS is more common if you have:

• Too much hair growth (hirsutism)
• Family history of HS
• Obesity
• A habit of smoking
• Hormone changes (puberty or menopause)
• Stress to your skin

Your environment and social factors may also play a role in your risk for HS, too

What Are the Symptoms of Hidradenitis Suppurativa?

Your symptoms can vary, but usually come on slowly as discomfort, and get better before flaring up again. Your HS can form:

• Firm bumps (nodules)
• Pus filled sores (abcesses)
• Sinus tracts (skin tunnels)

Inflamed bumps

Your nodule may:

• Be about the size of a built-in pencil eraser (0.5 centimeters)
• Get as big as a peanut (2 centimeters)
• Get inflamed
• Form more than one bump
• Last for many days to months
• Affect both sides of your body
• Fill up with pus
• Itch
• Go away and flare up again

Tombstone comedones

Many times, your older bumps can get two or more deep pits on them. The pitted scars often contain tiny blackheads called comedones.

Skin tunnels

Also called sinus tracts, these thin, deep passages connect different areas of HS outbreaks and can last months or years.

HS scars

After treatment, your bumps heal and form scars that can look:

• Pitted
• Rope-like
• Thick or raised (fibrotic)
• Scaly and dry (plaques)
• Nodules (small bumps)
• Acneiform (ice pick scars)
• Raised, hard, and thick (keloids)

Where Does Hidradenitis Suppurativa Form?

Blocked HS hair follicles commonly happen where your hair and skin rub together, such as your:

• Armpits
• Groin and inner thighs
• Between your buttocks, near your anus
• Between your anus and genitals (perineal area)
• Under your breasts

It happens less often, but HS also happens on your:

• Stomach
• Scalp
• Neck
• Behind your ears

What Are the Stages of Hidradenitis Suppurativa?

Your doctor can group your HS into Hurley stages, based on how serious your bumps get.

Stage 1

Single or multiple bumps without skin tunnels or scars.

Stage 2

Some bumps in different places that recur, with some skin tunnels and scars.

Stage 3

Many bumps that recur, with a lot of skin tunnels and scars over a large area.

How Is Hidradenitis Suppurativa Diagnosed?

Your doctor looks for three main things to diagnose hidradenitis suppurativa:

• Types of bumps
• Location of your bumps
• How often you get HS

Your doctor looks closely at your skin to check if you have:

• More than one bump
• Deep, inflamed lumps
• Paired or many pitted blackheads
• Skin tunnels
• Pus filled sores
• Deep, broken cysts (fibrous)

Other tests for hidradenitis suppurativa

To find skin tunnels before surgery, your doctor may order an ultrasound. And to rule out other conditions, your doctor may take a small sample of your bump for a biopsy.

What Are the Complications of Hidradenitis Suppurativa?

Complications can happen without treatment, but with medical care you can lower your risk for HS problems such as:

• Lymphatic system problems
• Swelling in your arms, legs, and genitals
• Not feeling well (mailase)
• Mental health conditions
• Anemia
• Fistulas
• Infections, cellulitis, or sepsis
• Arthritis
• Skin cancer (rarely)

How Do You Treat Hidradenitis Suppurativa?

Your doctor may suggest treating your HS with:

• Medicines
• Biologics
• Topical treatments
• Surgery

You'll make a skin care treatment plan with your doctor to help you manage your HS flare-ups and ease your daily living with HS.

NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) can ease your pain and help manage swelling, such as:

• Aspirin
• Ibuprofen
• Naproxen

But an abscess can keep you up at night and disturb your sleep. So, your doctor may prescribe medicine to help lower pain, inflammation, and swelling.

Oral antibiotics

Your doctor may also prescribe antibiotics such as:

• Clindamycin with dapsone (Aczone)
• Clindamycin with rifampin (Rifadin, Rimactane)
• Tetracyclines

Corticosteroids

To ease inflammation, pain, and swelling, your doctor may inject steroids into your bumps. Or they may suggest oral steroids, too.

Oral retinoids

Some acne medicines can also help HS:

• Acitretin (Soriatane)
• Isotretinoin (Accutane)

Topical treatments

Your doctor may also treat your HS with topical medicines:

• Resorcinol cream
• Clindamycin cream

Hormone therapy

Your doctor may suggest blocking hormones using:

• Birth control
• Spironolactone (Aldactone)
• Finasteride (Propecia)

Biologics

These medicines weaken parts of your immune response and may prevent new HS bumps from forming.

Your doctor may suggest:

• Adalimumab (Humira)
• Bimekizumab-bkzx (Bimzelx)
• Secukinumab (Cosentyx)

Although not FDA-approved, your doctor may also use:

• Anakinra (Kineret)
• Infliximab (Remicade)
• Upadacitinib (Rinvoq)
• Ustekinumab (Stelara)

Other medications

It's still unclear how well these treatments work, but your doctor may prescribe:

• Apremilast (Otezla)
• Metformin (Glucophage)
• Metronidazole (Flagyl, Nuvessa, and Noritate)
• Moxifloxacin (Avalox, Moxeza, Vigamox)
• Rifampin (Rifadin, Rimactane)
• Zinc supplements

Surgery

There are different surgeries to remove your bumps.

Drainage. For short-term relief, your doctor can make a small cut to drain pus in a small area.

Deroofing surgery. This procedure turns deep, painful bumps and pockets (which recur) into scars that won't hurt.

Wide excision. Your doctor cuts out problem spots and takes skin from another part of your body (skin graft) to repair it.

Laser surgery. Your doctor can destroy the hair follicles and shafts to clear new, deep bumps. But you may need many treatments before it works.

Success rates for HS surgery

In one study, only 3 people out of 11 had HS again after wide excision surgery. But in another study, 85 people out of 100 were happy with HS surgery.

What Lifestyle Changes Help With Hidradenitis Suppurativa?

Here are a few lifestyle changes to help you take care of your skin and live fully with HS.

Don't pop your bumps

Don't squeeze or pop your cysts or sores. Injury, irritation, or friction can bring on more bumps.

Use the right bandage

Your bandage can help heal your sores, if you:

• Keep it from rubbing
• Cover bumps with clear petroleum jelly
• Avoid sticky, adhesive tape
• Use elastic fishnet

Keep the area clean

Try to keep your bumps clean, and:

• Wash HS areas gently.
• Try acne wash (benzoyl peroxide or zinc pyrithione).
• Avoid scrubbing with washcloths or brushes.
• Use antibacterial soap (4% chlorhexidine can help with odors).

Heat compresses

With mild HS bumps, heat can help ease your pain, try a:

• Tea compress. Boil a black tea bag in water for 10 minutes and let it cool down. Once it's warm, put the tea bag on your bump for 10 minutes.
• Warm compress. Soak a clean washcloth in warm water. Wring it out before placing it on your skin for 10 minutes.

Stay cool

Brief warmth can give you relief, but too much heat can worsen your bumps.

To avoid overheating, you can try to limit your:

• Time outside during hotter months.
• Activity in hotter weather.
• Time in hot places, cool down inside.

Ask your dermatologist, but use a mild antiperspirant or deodorant to prevent sweat and choose one without:

• Alcohol
• Baking soda
• Parabens
• Dyes
• Fragrance

Wear loose-fitting clothes

Avoid leggings and most close-fitting clothing. Clothes that rub on your skin can irritate your HS and lead to flares.

Hair removal

Avoid waxing. But if you must shave, try to avoid nicks and cuts by:

• Washing with antibacterial soap
• Using a shaving gel
• Shaving carefully

You can also talk to your doctor about laser hair removal which can lower the number of hair follicles.

Lifestyle changes

You can make a few habit changes to lower your risk for flare ups, including:

• Reach your goal weight
• Quit smoking tobacco

Get support

HS can take an emotional toll because it develops around your genitals, breasts, and groin. Often misdiagnosed, your HS may cause you shame and can impact your mental health. Everyone feels differently, and some people may get self-conscious when their sores suddenly leak.

Talking to others about how you manage the painful cycle of HS can help — find support at HopeforHS.org.

When to call the doctor

Call your doctor if you have a wound that isn't healing and your wound:

• Worsens
• Opens up again
• Gets more painful

What Diets Help With Hidradenitis Suppurativa?

It's still unclear, but a few studies suggest some diets may help your hidradenitis suppurativa.

Weight loss diet

Losing 15% or more of your body weight may help your HS symptoms and lower flare-ups. In a small study on people with HS, about:

• Half the people reported their HS cleared up
• 20 people in 100 had fewer lumps

Mediterranean diet

A few small studies showed people with HS had fewer symptoms and flares after eating:

• Fresh veggies
• Fruits
• Whole grains
• Fish and seafood
• Beans
• Extra virgin olive oil
• Very little red meat
• No processed foods, sugary drinks, or cold cuts

Plant-based diet

A plant-based diet can help your gut grow many types of healthy microbes (bacteria). A few studies looked at gut bacteria and people with HS didn't have as many types. So try to eat more fruits and veggies for a healthier gut.

Sugar-free and dairy-free diets

Sugar can raise your insulin levels and may cause HS flare-ups. There's no proof, but some people found going sugar-free helped their HS.

One small study found going dairy-free meant fewer HS symptoms. If you cut out dairy, eat foods with the essential nutrients calcium and vitamin D.

Food sensitivity and diet changes

Food sensitivity can cause inflammation and trigger flare ups. Cutting back on certain foods may help. Talk with your doctor or nutritionist before you make any diet changes and how to replace any essential nutrients.

What Are Some Hidradenitis Suppurativa Myths?

It's rare

Actually, HS commonly affects about 1 to 4 out of 100 people in the world.

It's contagious

HS is not contagious and can't spread to other people — it's a chronic autoimmune reaction to clogged hair follicles that break open.

It's an STD

HS is not an STD; it's not a virus. Because HS often occurs near your groin, genitals, anus, or thighs, some people may think it's an STD — but it isn't.

It's caused by poor hygiene

HS is not linked to washing yourself or poor hygiene. Your skin is clean, and you didn't do anything to cause it.

It can't be treated

Yes, treatments and medicines can help improve your HS and lower your risk for flare ups.

What Is the Outlook for Someone With Hidradenitis Suppurativa?

There may be no cure, but the outlook is good for HS because many treatments can ease symptoms and lower your flareup risk.

Can You Live a Normal Life With Hidradenitis Suppurativa?

Hidradenitis suppurative can impact you emotionally but early treatment and support can help you feel better and live normally.

Takeaways

Hidradenitis suppurativa (HS) is a chronic condition where your immune system over reacts to hair roots that clog and bust open near sweat glands. Early treatment can ease symptoms and lower your flareup risk. Call your doctor if your HS bump isn't healing, opens up, or the pain worsens.

Hidradenitis Suppurativa FAQs

What clears up hidradenitis suppurativa?

Your doctor can help you make a treatment plan to best clear up your hidradenitis suppurativa and may prescribe:

• Medication
• Topical treatments
• Biologics
• Surgery
• Lifestyle changes

How do you treat a hidradenitis suppurativa flare-up?

Your doctor may prescribe:

• Antibiotics
• Topical clindamycin
• Topical resorcinol
• Oral steroids
• Laser therapy

Can you pop hidradenitis suppurativa bumps?

Don’t pop your HS bumps. Pressing or rubbing your skin can cause more symptoms and flare ups.

Is hidradenitis suppurativa hard to live with?

It's different for everyone, but the painful hidradenitis suppurativa cycle can take a physical and emotional toll. Treatment and support can help you enjoy and fully live life.

What should I ask my doctor about HS?

Here are some questions to ask your doctor:

• What treatments can help lower my risk for flare-ups?
• How should I care for my wounds?
• What is my skin care treatment plan?
• Are biologic medications a good option for me?
• What side effects can biologic medicines cause?
• Will I need surgery?