Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is an inflammatory disorder of hair follicles, most commonly in the armpits, groin, under the breasts, and in between the buttocks.

Depending on the stage of the disease, it may present with painful, tender papules (bumps on the skin), cysts, or nodules (larger lumps under the skin), and scarred down areas. Smelly pus may drain from the skin, and sometimes large tracts of pus form under the skin (called sinus tracts). The cause of HS is still unknown, but important strides have been made in better understanding the disease.

HS can occur in people of all ethnicities and all ages, but it may be more common in women, African Americans, and young adults. It has been associated with obesity and tobacco use, and patients are encouraged to lose weight and quit smoking. It may occur with other disorders of the hair follicle such as acne conglobata (a severe form of acne), pilonidal cysts (usually occur on the lower back and buttocks area), and dissecting cellulitis (severe hair loss with scarring of the scalp). There may also be an association with inflammatory bowel disease. HS significantly affects patients’ lives. Patients with HS have been shown to have higher rates of depression than those without the disorder.

Biopsies, infectious cultures, and laboratory tests are of limited use in HS. The diagnosis is usually made by a dermatologist, who takes into account how long the disease has been present, the types of skin findings, and the location of these skin findings. While HS may occur more commonly if a family member is affected, it often occurs in people without any known family history of the disorder.

There is no cure for HS, but many treatments are available based on the stage of the disease. For mild to moderate disease, treatment options include antibiotic creams and lotions, antibiotic washes, oral antibiotics, local steroid injections, small surgical procedures, laser treatments, and pills that regulate hormones. For more severe disease, these treatments may still be helpful, as well as injectable biologic agents, larger surgical procedures, immunosuppressive pills (medications that suppress the immune system), and other oral medications. Patients are encouraged to quit smoking, maintain a healthy weight, and wear looser-fitting clothing.

Conflict of Interest Disclosures: None reported.