Hidradenitis Suppurativa

What is hidradenitis suppurativa (HS)?

Hidradenitis suppurativa (HS) is a condition that causes painful, recurring boils in areas of your body with sweat glands. There isn’t a cure, but treatment can help manage symptoms and prevent new boils and scarring.

Another name for HS is acne inversa.

What types of skin growths does HS cause?

• Nodules: Firm lumps beneath your skin’s surface.
• Abscesses: Pockets of pus that may drain and cause a strong odor.
• Sinus tracts: Channels that form between the abscesses and the surface of your skin.

Who is more likely to experience hidradenitis suppurativa?

Women and people assigned female at birth (AFAB) are more likely to get HS compared to men and people assigned male at birth (AMAB).

Other risk factors include:

• Excessive hair growth (hirsutism).
• Family history of HS.
• Fluctuating sex hormones (estrogen and androgens), which is common after puberty and before menopause.
• Smoking.
• Obesity.

Is hidradenitis suppurativa contagious?

HS isn’t contagious because it has nothing to do with infection. It’s an autoinflammatory condition that affects your hair follicles.

What causes hidradenitis suppurativa?

HS is an autoinflammatory disease of the hair follicles. This means your body attacks your hair follicles, resulting in abscesses, chronic inflammation and scarring.

Is hidradenitis suppurativa due to an STD?

No, HS isn’t a sexually transmitted infection (STI). It’s not contagious at all.

Is hidradenitis suppurativa due to poor hygiene?

No, HS isn’t a consequence of poor hygiene.

What are hidradenitis suppurativa symptoms?

People with HS develop painful nodules, abscesses that drain pus and scarring over time. Women and people AFAB may experience flare-ups before their period.

Where do hidradenitis suppurative boils form?

Commonly affected areas include your:

• Armpits.
• Anus (butthole).
• Buttocks.
• Crease under your breasts.
• Genitals.
• Groin.
• Inner thighs.
• Nape of your neck.
• Waist.

Is hidradenitis suppurativa the same as acne conglobata?

Some people with HS may also develop acne conglobata, a severe type of acne.

What are common HS complications?

Longstanding untreated HS increases your risk of:

• Anemia.
• Cellulitis.
• Damage to your body’s lymphatic system.
• Fistula, an abnormal connection between your skin and bowel or bladder.
• Scars.
• Sepsis.
• Skin cancer (rare).

What type of healthcare provider should I see for a hidradenitis suppurativa evaluation?

Unfortunately, many healthcare providers may mistake HS for infection-related boils. A dermatologist has special training that helps them recognize the signs of hidradenitis suppurativa.

How is hidradenitis suppurativa diagnosed?

A review of your health history and a physical exam is typically all that’s necessary.

How is hidradenitis suppurativa treated?

Hidradenitis suppurativa treatment depends on the severity of your symptoms. In early stages, your care may include:

Skin care plan

A dermatologist may recommend specific skin care products. These include:

• Antiperspirants that are gentle on delicate skin.
• Daily antiseptic wash to cleanse affected areas.
• Retinoids, substances that contain vitamin A and help reduce inflammation.
• Specific types of body wash.

Pain management

Hidradenitis suppurativa treatment also includes therapies to relieve pain:

• Complementary medicine, including dietary mind-body techniques and acupuncture.
• Ice packs or warm compresses.
• Lidocaine skin cream or ointment.
• Over-the-counter (OTC) or prescription pain medications.
• Referral to a pain management specialist.

Additional medical therapies

Other medications that help people with hidradenitis suppurativa include:

• Adalimumab, a biologic therapy that quiets your body’s immune system response. This can ease inflammation.
• Antibiotics, in the case of HS, aren’t used to treat an infection. Instead, healthcare providers use them to treat the inflammation that drives the condition. For ongoing inflammation, your provider may prescribe a three-month course of low-dose antibiotics.
• Metformin, a diabetes medication that may help HS by normalizing hormone levels and decreasing insulin resistance.
• Birth control pills, oral contraceptives that regulate hormone fluctuations and can help prevent or lessen the severity of premenstrual flares.

What therapies are available for advanced hidradenitis suppurativa?

If you have severe symptoms or growths that don’t respond to other therapies, you may need a procedure.

Your healthcare provider may recommend:

• Botox® injections to control excessive sweating.
• Deroofing, surgery to remove the skin coverings of sinus tracts.
• Incision and drainage to treat abscesses.
• Laser hair removal.
• Laser surgery to remove hidradenitis suppurativa boils.
• Steroid injections to reduce inflammation.

What can I do to prevent hidradenitis suppurativa?

Some risk factors, like family history, are out of your control. But there are steps you can take to lower the risk of HS flare-ups and complications.

Prevention may include:

• Limit sweating by staying indoors when it’s hot outside.
• Lose weight if you have obesity (a BMI, or body mass index, greater than 30).
• Don’t use scented deodorants or skin products.
• Quit smoking if you use tobacco. (A healthcare provider will have resources to help you.)
• Wear loose-fitting clothing.

What is the outlook for people living with HS?

The outlook is good. There are several treatments currently available that can help people with hidradenitis suppurativa. Experts are also testing new potential treatments.

Does hidradenitis suppurativa go away?

There’s no cure for hidradenitis suppurativa. It’s an ongoing skin condition with symptoms that may come and go for years. Treatments can manage symptoms and clear up boils. But there’s still a chance they could come back.

What’s it like living with hidradenitis suppurativa?

Recurrent draining abscesses make many people feel self-conscious. The stress of taking care of a chronic, painful condition can also impact mental health. Anxiety or depression are common in people with HS. If you’re struggling with these issues, talk to your healthcare provider.

A note from Cleveland Clinic

Hidradenitis suppurativa (HS) is a painful condition that causes recurrent painful draining boils and can lead to scarring. If you have painful boils that last for weeks and keep coming back in the other areas mentioned above, please see a healthcare provider. Medical therapies, procedures and counseling, when necessary, can help you get relief.