Causes & Symptoms
Hidradenitis suppurativa (HS) is a chronic inflammatory condition affecting areas of the body with apocrine glands (particular types of sweat glands). This condition can affect men, but is more common amongst women and tends to start after puberty.
The main areas affected are the armpits, groin and under the breasts. Hidradenitis suppurativa may start with pimples and progress to nodules (lumps) and boils (abscesses) under the skin. When these become connected together, tunnels under the skin (sinus tracts) may form. Scarring can occur when these tracts try to heal.
The cause of hidradenitis suppurativa is not completely clear. Risk factors for the development of HS include:
- Raised hormone levels. We do not know exactly how hormones affect HS, but androgen levels (testosterone) rise after puberty, when people are more susceptible to this condition.
- Other conditions such as acne and polycystic ovary syndrome (PCOS).
Treatment at The Skin Hospital
HS is difficult to treat, however there are many different effective treatments.
- Cessation of smoking and weight loss can be very helpful in improving symptoms.
- Washing with a mild antiseptic wash (e.g. chlorhexidine) can help reduce the bacterial load on the skin.
Oral treatments (1):
- Tetracycline antibiotics (taken over months) can work by reducing inflammation.
- Other oral antibiotics may be required for shorter durations to treat acute infection from problem abscesses..
- The oral contraceptive pill (anti-androgen type) can be helpful in women.
- Retinoids (which are derived from vitamin A, e.g. isotretinoin and acitretin) can be effective. These cannot be used in pregnant women or those planning a pregnancy.
Oral treatments (2): immunomodulators
- If the condition is resistant to other treatments, tablet medications that dampen down the immune system (such as methotrexate and ciclosporin) can be used.
- Clinical trials are being undertaken to assess the effectiveness of biologic agents (such as adalimumab and infliximab) in HS.
- Surgery can also be considered in some cases. Incision and drainage of specific abscesses is sometimes necessary. Excision of the affected skin in some areas can be useful, but generally does not produce a cure. This condition can be psychologically distressing and greatly affect quality of life due to pain and the physical appearance of the skin affected by the disease; psychological support is important in the management of this condition.
If you would like further information on hidradenitis suppurativa the below sites provide more in-depth descriptions of the types and causes of HS:
Additionally there are also patient support groups, for patients and their families: