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Hidradenitis suppurativa

Medically reviewed by Drugs.com. Last updated on Jun 6, 2023.

Overview

Hidradenitis suppurativa (hi-drad-uh-NIE-tis sup-yoo-ruh-TIE-vuh), also known as acne inversa, is a condition that causes small, painful lumps to form under the skin. The lumps usually develop in areas where your skin rubs together, such as the armpits, groin, buttocks and breasts. The lumps heal slowly, recur, and can lead to tunnels under the skin and scarring.

Hidradenitis suppurativa tends to start after puberty, usually before age 40. It can persist for many years and worsen over time. It can affect your daily life and emotional well-being. Combined medical and surgical therapy can help manage the disease and prevent complications.

Women are three times more likely to develop hidradenitis suppurativa, though this ratio can differ by location around the world. Also, Black people are more likely to develop this disease than people of other races. This could be attributed to genetic factors.

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Hidradenitis suppurativa

Illustration of hidradenitis suppurativa on different skin colors. This condition usually appears as one or more tender bumps that fill with pus. It often occurs in the armpits.

Symptoms

Hidradenitis suppurativa can affect one or several areas of the body. Signs and symptoms of the condition include:

Some people with this condition experience only mild symptoms. The course of the disease is highly variable. Excess weight and being a smoker are associated with worse symptoms, but people who are thin and don't smoke can experience severe disease.

When to see a doctor

Early diagnosis of hidradenitis suppurativa is key to effective treatment. See your dermatologist if your condition:

Your dermatologist can create a treatment plan for you.

Hidradenitis suppurativa is not just a boil, and many people with this condition also have related conditions. People with hidradenitis suppurativa benefit from a health care team with medical and surgical dermatologists at the core. Other specialists are involved as needed.

Causes

Hidradenitis suppurativa develops when hair follicles become blocked, but why this blockage occurs isn't known. Experts think it could be connected to hormones, genetic predisposition, cigarette smoking or excess weight.

An infection or being unclean does not cause hidradenitis suppurativa, and it can't be spread to other people.

Risk factors

Factors that increase your chance of developing hidradenitis suppurativa include:

Complications

Persistent and severe hidradenitis suppurativa can cause complications, including:

Diagnosis

Hidradenitis suppurativa can be mistaken for pimples or acne. For many people, it takes years to receive a correct diagnosis.

Your health care provider will base a diagnosis on your signs and symptoms, skin appearance, and medical history. You might be referred to a health care provider who specializes in skin conditions, also known as a dermatologist. Hidradenitis suppurativa can be difficult to diagnose and requires specialized care.

No laboratory test is available to diagnose hidradenitis suppurativa. But if pus or drainage is present, your health care provider might take a sample for lab testing.

Treatment

Treatment with medicines, surgery or both can help control symptoms and prevent complications of hidradenitis suppurativa. Talk with your health care provider about the risks and benefits of the treatment options and how to develop an approach that's right for you.

Expect to have regular follow-up visits with your dermatologist. Some people might need the comprehensive care provided by a health care team with members from multiple medical specialties.

Medications

Your health care provider might prescribe one or more of these types of medicines:

Surgery or other procedures

Combined medical and surgical approaches help manage hidradenitis suppurativa. Surgery is an important part of disease management when a tunnel, and bump, or abscess, are present. Which surgical approach is right for you depends on the extent and severity of your condition. Talk with your health care provider about the risks and benefits of the options, including:

Lifestyle and home remedies

Mild hidradenitis suppurativa can sometimes be effectively controlled with self-care measures. Self-care is also an important complement to medical treatment.

These suggestions might relieve discomfort, speed healing or prevent flare-ups:

Coping and support

Hidradenitis suppurativa can be a challenge to your emotional health and well-being. Painful sores might affect your sleep, ability to move or sex life. Or the sores might drain pus with an odor, which might make you feel anxious, embarrassed, angry, self-conscious or depressed. The ongoing, persistent nature of the disease and its treatment challenges add to the burden.

Try to find support among your family and friends. The concern and understanding of other people with hidradenitis suppurativa also might be comforting. Ask for help with your mental health and coping strategies. Your health care provider can refer you to a mental health professional or provide the contact information for a support group.

Preparing for an appointment

You'll likely first see your primary care provider. You might then be referred to a health care provider who specializes in diagnosing and treating skin diseases, also known as a dermatologist. Depending on the severity of your condition, your care also might involve specialists in colorectal surgery, plastic surgery or gastroenterology.

Here's some information to help you get ready for your appointment.

What you can do

Make a list of:

Also, note the questions to ask your health care provider, including:

What to expect from your doctor

Your health care provider is likely to ask you several questions, such as:

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