Hidradenitis suppurativa (HS), also known as acne inversa, is an inflammatory disease that causes bumps to appear on the skin. While these bumps may resemble pimples or boils, they appear in places where acne usually does not, such as the underarms and groin.
Many people have HS for life. When the condition is diagnosed early, a board-certified dermatologist can recommend effective treatment options to help control the symptoms and prevent the condition from getting worse.
What does HS look like?
If you have HS, you will notice bumps on your body in areas where skin touches skin. This condition is most common in the armpits and groin. It also may appear on and under the breasts, on the buttocks, and around the anus.
HS bumps may look like pimples, deep acne-like cysts or blackheads, folliculitis (swollen pimples with a hair in the center), or boils. If they break open or rupture, the bumps can leak a blood-stained, foul-smelling pus.
As HS gets worse, the bumps can grow larger and become painful, hot and tender.
As the bumps heal, they can cause deep scars that look like tunnels under the skin. These scars can thicken over time and may be painful.
Because of the scarring and pain associated with HS, patients may experience a limited range of motion in areas where the bumps appear.
Who gets HS?
Although HS can affect people of any age, it is most common in individuals between the ages of 15 and 30. Women, people who are overweight or obese, and smokers have a higher risk of developing HS than the general population. Your risk also increases if you have a blood relative with HS.
What causes HS?
HS forms when hair follicles and certain sweat glands become clogged with dead skin cells and other substances. While researchers have not determined the exact cause of HS, scientists believe that it may develop when the immune system overreacts to these clogged hair follicles. Dermatologists do know that HS is not contagious and that it is not caused by poor hygiene.
How does a board-certified dermatologist diagnose HS?
While HS can look like acne, boils and other skin diseases, the trained eye of a board-certified dermatologist can distinguish among these conditions. To diagnose HS, the dermatologist will look at your skin and ask specific questions. If your HS sores are leaking fluid, the doctor may swab some of this fluid onto a slide to see if there is an infection.
How does a board-certified dermatologist treat HS?
There are a variety of treatments for HS. No one treatment works for everyone, and you may need to try multiple treatments to find one that works for you. A board-certified dermatologist can discuss your treatment options with you.
- Antibiotics: Antibiotics, which can be applied to the skin or taken as pills, can be effective in the early stages of HS. They can help fight infection, decrease inflammation, prevent the condition from getting worse and stop future outbreaks.
- Antimicrobial washes and medicines: Antimicrobial washes such as benzoyl peroxide or chlorhexidine, which are available over-the-counter, may be helpful, although they usually will not clear HS on their own.
- Corticosteroids: Your dermatologist can inject this medicine into an HS bump to help reduce pain and swelling. You also may take corticosteroid pills to help reduce inflammation, which can help clear HS and prevent new symptoms.
- Diabetes medication: Metformin, which is approved by the U.S. Food and Drug Administration for the treatment of adult-onset diabetes (type II diabetes), also may help people who have HS and a condition called metabolic syndrome.
- Hormone therapy: Medicines that regulate hormones, including birth control pills and spironolactone, can decrease pain and the amount of fluid draining from HS breakouts.
- Immunotherapy: Drugs that target the immune system, including methotrexate and biologics like adalimumab, may be used to treat moderate to severe HS. Because of the potentially serious side effects associated with this medication, you should discuss the risks and benefits with your dermatologist.
- Oral retinoids: Retinoids can stop the pores from producing too much oil, which helps prevent clogged hair follicles. This treatment will only work in certain HS patients.
How can I manage my HS symptoms?
Dermatologists recommend the following tips for easing the symptoms of HS:
- Lose weight if you are overweight.
- Do not smoke; if you are currently a smoker, take steps to quit.
- Do not shave where HS forms.
- Wear loose-fitting clothing.
- Avoid overheating and sweating.
Get the Care You Need from Knowledgeable Professionals
Patients with HS often have trouble finding doctors who recognize this disease. Some patients report that it takes years to make the diagnosis and others describe trips to many doctors before they can get help for their condition.
At The GW Medical Faculty Associates, we are committed to treating patients with HS and we have developed a multidisciplinary team to focus on coordinated care. Our team of dedicated professionals provide coordinated care for HS patients that is focused on improving symptoms and controlling disease activity.
Schedule an Appointment
Talk to your doctor about a referral to the GW Hidradenitis Suppurativa Team. Call 202.741.2600 for an appointment.