Overview
Hidradenitis suppurativa is a condition that causes small, painful lumps to form under the skin, usually in areas where your skin rubs together such as the armpits, groin, buttocks, and breasts. These lumps tend to recur, heal slowly, and can lead to tunnels under the skin and scarring. The condition often starts after puberty and can persist for many years, worsening over time. Women are three times more likely to develop hidradenitis suppurativa, and Black people are more likely to develop this disease than people of other races. Smoking has been linked to the development of hidradenitis suppurativa. Complications can include infection, scars, restricted movement, and skin cancer. Early diagnosis and treatment are important to manage the disease effectively.
Understanding the disease
Symptoms
The symptoms of hidradenitis suppurativa include blackheads, painful pea-sized lumps, leaking bumps or sores, and tunnels. The condition usually begins with a single, painful lump that persists for weeks or months. More bumps may form later in areas with high sweat and oil gland concentration or skin friction. Some bumps may break open and drain pus with an odor. Over time, tunnels might form under the skin, connecting the lumps. The disease can cause complications such as infection, scars, restricted movement, and skin cancer in severe cases. Hidradenitis suppurativa typically starts after puberty and can persist for many years. Women are more likely to develop the condition than men, and people with Black race are more susceptible to it.
Risk Factors
The risk factors for developing hidradenitis suppurativa include age (higher risk for people in their teens and 20s), sex (females are more likely to develop it than males), race (the condition is more common in Black people), family history, certain conditions (overweight, severe acne, arthritis, diabetes, metabolic syndrome, and inflammatory bowel disease), and smoking.
Development
Hidradenitis suppurativa develops when hair follicles become blocked, which is not caused by an infection or being unclean. The exact cause of this blockage is not known, but it is believed to be connected to hormones, genetic predisposition, cigarette smoking, or excess weight. The condition primarily affects areas where skin rubs together, such as the armpits, groin, buttocks, and breasts. It usually starts after puberty, tends to persist for many years, and can worsen over time. Women are more likely to develop hidradenitis suppurativa, and Black people are at a higher risk than people of other races.
Assessment and Diagnosis
Triage
You should see a doctor if hidradenitis suppurativa is suspected when:
- The condition is painful.
- Movement becomes difficult due to the symptoms.
- The condition does not improve within a few weeks.
- The condition returns within weeks of treatment.
- The appearance of the condition is in several locations.
- The condition flares often. A dermatologist can create a treatment plan for you. It's important to seek medical help for hidradenitis suppurativa, as early diagnosis and treatment can improve its management.
Diagnosis
To diagnose hidradenitis suppurativa, your health care provider will base the diagnosis on your signs and symptoms, skin appearance, and medical history. They may refer you to a dermatologist who specializes in skin conditions for further evaluation. There is no specific laboratory test available to diagnose hidradenitis suppurativa, but if pus or drainage is present, your health care provider might take a sample for lab testing.
Management and Treatment
Complications
The potential complications of hidradenitis suppurativa include infection, scars and skin changes, restricted movement, and skin cancer. Hidradenitis suppurativa can also cause swelling in the arms, legs, or genitals due to interference with the lymph drainage system. Additionally, it can lead to psychological effects and social isolation, as well as lifelong pain. It's important to note that hidradenitis suppurativa is not caused by being unclean or an infection, and it cannot be spread to others.
Treatment
Treatments for hidradenitis suppurativa include both medical and surgical approaches. The treatment plan is often tailored to individual needs and can involve a combination of methods. Here are some common treatments:
- Topical prescription medications: Your dermatologist may prescribe topical medications such as retinoids, antibiotics, or corticosteroids to help reduce inflammation and bacterial growth.
- Oral antibiotics: If the condition is severe or widespread, your doctor may prescribe oral antibiotics to help manage the infection and reduce inflammation.
- Biologic therapy: Biologic therapies, such as adalimumab (Humira) and infliximab (Remicade), can be used to target specific immune system factors that contribute to the development of hidradenitis suppurativa.
- Surgical intervention: In some cases, surgical intervention may be necessary to remove severely affected tissues and promote healing. This can involve incision and drainage, excisional surgery, or laser therapy.
- Lifestyle modifications: Maintaining a healthy weight, quitting smoking, and keeping the affected areas clean and dry can help manage the condition and prevent recurrence.
- Wound care: Proper wound care, including cleaning and dressing changes, is essential to prevent infection and promote healing. It's important to work closely with your healthcare provider to determine the most effective treatment plan for your specific case. Early diagnosis and appropriate management can help improve the quality of life and prevent complications.
Preparing for medical consultation
To prepare for an appointment for hidradenitis suppurativa, follow these steps: