Hidradenitis suppurativa: Pictures, treatment, and symptoms (original) (raw)

Hidradenitis suppurativa is a chronic, relapsing skin condition that causes painful abscesses and scarring.

Hidradenitis suppurativa affects approximately 1–4% of the population worldwide. It is more common among females than males.

In this article, learn more about hidradenitis suppurativa, including its stages, causes, symptoms, and treatment options.

Hidradenitis suppurativa is a chronic skin condition. It is sometimes called acne inversa.

It causes small, inflamed nodules that can become very swollen and large. They may sometimes rupture and leak pus.

Hidradenitis suppurativa cysts can resemble other skin conditions, such as:

However, unlike other common skin sores, hidradenitis suppurativa tends to affect different body regions and cause major scarring. The scars can interfere with movement and a person’s quality of life.

Here are some pictures of hidradenitis suppurativa:

Without early diagnosis and treatment, hidradenitis suppurativa can sometimes progress and cause severe scarring.

If a primary care physician cannot manage a person’s hidradenitis suppurativa with standard treatment, they may refer the person to a board certified dermatologist for more advanced treatment options.

People who receive a diagnosis of hidradenitis suppurativa have several available treatment options, which focus on:

Many medications can help treat minor to moderate cases of hidradenitis suppurativa. These medications include:

In severe cases, a dermatologist might recommend more aggressive treatments that may be more effective but can come with more side effects.

People should always discuss the potential benefits and risks of treatments with a dermatologist.

Common treatments for severe hidradenitis suppurativa include biologics. These medications act on the immune system.

In 2015, the Food and Drug Administration (FDA) approved the use of the injectable biologic medication adalimumab (Humira) for moderate to severe hidradenitis suppurativa.

Doctors may prescribe other biologics, such as the popular psoriasis biologic ustekinumab (Stelara), but this use is off-label.

Doctors may also prescribe oral retinoids to treat the condition. These drugs are derived from vitamin A. They are only occasionally effective as an off-label option for some people with hidradenitis suppurativa.

In some severe cases or those that do not respond to other therapies, a dermatologist may perform or refer a person for a surgical procedure. These procedures can include:

However, surgery for hidradenitis suppurativa does not guarantee success.

A 2020 study including 75 people with hidradenitis suppurativa and a median age of 31.4 years found a recurrence rate of 35% after excision surgery.

However, two-thirds of the study participants said they were satisfied with their surgery and would recommend it.

People with hidradenitis suppurativa may first develop small pimple-like bumps, sores, or boils on the skin.

Unlike regular pimples, these sores are usually recurrent. They can affect both sides of the body and tend to develop in areas where the skin folds or experiences friction. These areas include the:

Less commonly, hidradenitis suppurativa sores may also appear on other areas of the body.

Hidradenitis suppurativa may clear up for days, weeks, or months, then come back.

For some people, the sores develop in the same place each time. For others, the sores appear elsewhere. Hidradenitis suppurativa is a lifelong condition.

Diet may play a role in the severity of hidradenitis suppurativa.

According to a 2019 study, a dairy-free diet may help reduce the clinical severity of hidradenitis suppurativa. A diet free of dairy and brewer’s yeast may also reduce symptom severity.

The early stages of hidradenitis suppurativa tend to cause vague symptoms that a person can easily mistake for those of another skin condition.

Common early symptoms of hidradenitis suppurativa include:

In some people, the sores are more severe. Signs and symptoms of severe hidradenitis suppurativa include:

All hidradenitis suppurativa sores can be painful, tender, and cause scarring. In severe cases, extensive scarring and large or leaking infections can affect a person’s quality of life.

A dermatologist may determine the severity of hidradenitis suppurativa using the Hurley stages:

Researchers do not know exactly why hidradenitis suppurativa develops, but the nodules tend to result from blocked hair follicles.

Sex hormones may play a role in the development of hidradenitis suppurativa. Most people first experience symptoms after puberty.

The immune system could be a factor in the development of hidradenitis suppurativa. One theory is that the immune system overreacts to minor infections in clogged hair follicles.

Many people with hidradenitis suppurativa have a relative with the condition, so it may have a genetic component. Research has linked it to changes in the following genes: NCSTN, PSEN1, and PSENEN.

People do not develop the condition due to poor hygiene. Hidradenitis suppurativa is not contagious.

There is no known cure for hidradenitis suppurativa. It is a chronic condition that needs management. People with hidradenitis suppurativa will not always respond the same to treatment.

A few at-home remedies may help reduce symptoms if a person uses them alongside other treatments. These home remedies include:

A person with hidradenitis suppurativa will typically have scars and dyspigmentation. Visible scars may cause psychological distress in some people. The scarring may cause pain and limited mobility.

A person with hidradenitis suppurativa may have to change their lifestyle. The complications of hidradenitis suppurativa may make it difficult to work, go to school, and do physical activity.

The social stigma of hidradenitis suppurativa may cause psychological distress. A person with hidradenitis suppurativa may want to find a social support group and a flexible job.

Smoking and obesity are risk factors for the condition. If a person smokes, they may want to consider quitting. If a person has obesity, they may want to consider losing weight with their doctor’s help.

Here are some questions people often ask about hidradenitis suppurativa:

What triggers hidradenitis suppurativa?

Smoking and obesity are the most common triggers of hidradenitis suppurativa. However, what triggers hidradenitis suppurativa for one person may not be the case for another.

Does hidradenitis suppurativa ever go away?

Hidradenitis suppurativa is a lifelong, chronic condition that must be managed. For some people, symptoms may lessen or eventually stop with treatment.

What are the stages of hidradenitis suppurativa?

Hidradenitis suppurativa is classified according to the Hurley staging system. It ranges from stages 1–3. Stage 1 is the mildest form. Stage 3 is the most severe.

Is hidradenitis suppurativa an autoimmune disease?

Some researchers believe that hidradenitis suppurativa may be an autoimmune disease. People with the condition develop antibodies. However, this finding alone does not mean it is definitely an autoimmune disease. More research is needed.

Hidradenitis suppurativa is a long-term skin condition. It can be painful and cause scarring.

The condition requires regular management. A dermatologist can help find the best medications, home remedies, and other treatments to manage hidradenitis suppurativa symptoms.

People who find their symptoms particularly challenging may benefit from joining a local support group.