Hidradenitis suppurativa (HS), also known as acne inversa, is a painful skin condition characterized by lumps that form under the skin. These lumps, which are often mistaken for large pimples or acne, typically develop in areas where skin rubs together, such as the armpits, groin, under the breasts, and inner thighs. Without treatment, the lumps can turn into pus-filled pockets, known as abscesses, that may leak and leave scars.

Dermatologists, who specialize in skin conditions, diagnose and treat hidradenitis suppurativa. While there is no cure for HS, treatments can help manage symptoms, heal wounds, reduce flare-ups, and prevent the condition from getting worse.

Medications

Several medications can be used to treat hidradenitis suppurativa. These include:

Topical medications
Applied directly to the skin, topical treatments work locally where they are applied. Common topical treatments include:

  • Antibiotic creams like Aczone (dapsone) or clindamycin, which help treat infected lumps.

  • Resorcinol: A peel used to unclog hair follicles and reduce inflammation.

  • Lidocaine: Often used in combination with an ice pack to control pain.

Oral medications
Oral treatments work systemically, affecting the entire body. Common oral medications for HS include:

  • Antibiotics: Antibiotics from the tetracycline family are particularly effective in treating HS by addressing bacterial infections.

  • Acitretin: A retinoid used for severe psoriasis that promotes healthy skin growth.

  • Hormonal medications: Spironolactone or birth control pills can reduce androgens (hormones that contribute to acne-like conditions).

  • Metformin: A diabetes drug that reduces inflammation and may benefit people with both diabetes and HS.

  • Steroids: Drugs that reduce inflammation.

  • Humira (adalimumab): An FDA-approved biologic medication used to treat inflammatory conditions like rheumatoid arthritis and psoriasis. Humira can also help reduce HS symptoms.

  • Cymbalta (duloxetine): A medication used to treat depression and chronic pain, which can help with the symptoms of depression associated with HS.

In-Office Procedures

If left untreated, hidradenitis suppurativa can worsen, leading to the formation of pus-filled tunnels under the skin known as sinus tracts. In these cases, your dermatologist may recommend one or more procedures to manage the condition:

Botox (botulinum toxin)
FDA-approved for hyperhidrosis (excessive sweating), Botox injections may indirectly improve HS symptoms by reducing sweating.

Corticosteroid injections
Steroids injected into early HS nodules can reduce inflammation before they progress into more severe forms.

Incision and drainage
A dermatologist can drain painful abscesses to relieve pressure and pain. However, abscesses may return in the same spot.

Laser hair removal
Removing hair from affected areas can reduce HS lumps. Multiple treatments may be required to control the condition.

Deroofing
If a lesion keeps returning in the same spot, deroofing involves removing the top layer of skin, allowing the wound to heal. This helps reduce the risk of recurrence.

Wide excision
In cases where medications don’t work, a wide excision may be necessary to remove the entire lesion, including the tunnel beneath the skin. The wound is left open to heal on its own, and this procedure is often combined with medications.

Wound Care

Hidradenitis suppurativa can result in slow-healing wounds, so proper wound care is essential. Your dermatologist will advise you on the best type of care, which may include changing dressings regularly, soaking the wounds, or using antiseptic washes.

Lifestyle

Managing hidradenitis suppurativa at home can help alleviate symptoms and prevent flare-ups. Dermatologists recommend:

Avoid smoking
Quitting smoking can significantly improve HS symptoms for some people. If you need help quitting, consult your healthcare provider.

Take care of your skin
Certain soaps and lotions may irritate the skin of people with HS. Antimicrobial soap like benzoyl peroxide may be recommended, or you may need to find gentler skincare products.

Wear loose clothing
Tight clothing can rub against the skin, worsening symptoms. Loose clothing can help reduce friction and discomfort.

Avoid sweating
Excessive sweating can worsen HS symptoms. Try to stay cool during exercise by using air conditioning or avoiding the hottest parts of the day.

Try acupuncture
Acupuncture has been shown to relieve pain caused by HS and may be beneficial in managing the condition.

Laser Surgery

Laser surgery may be considered for severe cases of hidradenitis suppurativa. It can help remove scar tissue and lumps under the skin, providing relief. However, surgery is only recommended after HS has been controlled through other treatments. Full recovery can take up to six months.

Living With And Managing Hidradenitis Suppurativa

Hidradenitis suppurativa affects approximately 1 in 100 people. However, due to its relative obscurity, many people suffer in silence for years before seeking help. If left untreated, HS can cause severe scarring and negatively affect quality of life.

Living with HS can be emotionally challenging. It may cause chronic pain and lead to symptoms of depression. Lesions may leak foul-smelling fluid, further contributing to emotional stress.

Despite these challenges, hidradenitis suppurativa can be managed effectively. Early intervention is key to reducing symptoms and preventing the condition from progressing. Treatment often involves a combination of medications, procedures, and lifestyle changes tailored to your needs.

A Quick Review

Hidradenitis suppurativa is a complex skin condition that requires careful management. While there is no cure, a combination of treatments, including medications, procedures, and lifestyle changes, can help manage symptoms and prevent flare-ups. If you suspect you have HS, consult a healthcare provider or dermatologist for an accurate diagnosis and personalized treatment plan.