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(Acne Conglobata; Acne Inversa [AI]; Apocrine Acne; Apocrinitis; Fox-Den Disease; HS; Hydradenitis Suppurativa; Pyodermia Significa Fistulans; Velpeau's Disease; Verneuil's Disease)
Hidradenitis suppurativa (HS) is an inflammatory condition of the hair follicle. Inflamed nodules and cysts form in the armpits and groin. These may also be found under the breasts, and around the nipples and anus. Less commonly other areas of the body can be affected.
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The hair follicle becomes blocked causing inflammation. The blockage may lead to absesses, infection, or scarring. The sweat glands may also become inflamed.
Menstruation in women, weight gain, stress, hormonal changes, heat, and excessive perspiration may trigger the condition.
HS is more common in women than in men. Other factors that increase your chance of HS include:
HS usually presents at puberty, but may occur at any age after that. It may cause:
- Burning, itching, or painful lumps in the armpits, groin, under the breasts, around the nipples or anus, and other involved areas
- Pus leaking from openings in the lumps
You will be asked about your symptoms and medical history. A physical exam will be done. In most cases, the doctor will be able to make a diagnosis by looking at the abscesses and nodules.
Sometimes cultures will be done of the drainage. Occasionally, other blood tests or an ultrasound of the lesions is done.
The treatment will depend on the stage of the disease. Talk with your doctor about the best treatment plan for you. Options may include one or more of the following:
Home Care and Lifestyle Changes
You may be able to improve the condition by taking these steps:
- Use warm compresses to relieve discomfort and promote abscess drainage.
- Avoid shaving if your skin becomes irritated.
- Wear loose-fitting, non-synthetic clothing.
- Use antibacterial soap.
- Try to avoid heat and humidity.
Your doctor may prescribe 1 or more medications depending on the severity of your HS.
Your doctor may recommend oral or topical antibiotics.
Corticosteroids and Other Immunosuppresants
Corticosteroids may help improve symptoms. These can be taken by mouth, applied to the skin, or injected into the area.
Other medications called biologics, which decrease the body's immune response, may be used in severe cases. These medications have many risks, so your doctor will carefully weigh the risks and benefits of using these.
Hormonal medications, such as oral contraceptives can be used in some cases. At other times, medications called retinoids may be used.
Small lesions can be treated in the doctor's office. The sores may be cut open and allowed to drain. If your condition is severe, then a wide area may need to be removed. In these cases, a skin graft may be needed.
Other procedure options include:
- Laser surgery—uses lasers to remove lesions
- Cryosurgery—uses cold to freeze lesions
- Laser hair removal
American Academy of Dermatology
Hidradenitis Suppurativa Foundation
Canadian Dermatology Association
Hidradenitis suppurativa. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. February 1, 2016. Accessed May 9, 2016.
Hidradenitis suppurativa. National Organization of Rare Diseases website. Available at: http://rarediseases.org/rare-diseases/hidradenitis-suppurativa/. Updated 2012. Accessed May 9, 2016.
Lam J, Krakowski AC, Friedlander SF. Hidradenitis suppurativa (acne inversa): management of a recalcitrant disease. Pediatr Dermatol. 2007;24(5):465-473.
Shah N. Hidradenitis suppurativa: a treatment challenge. Am Fam Physician. 2005;72(8):1547-1552.
Fardet L, Dupuy A, Kerob D, et al. Infliximab for severe hidradenitis suppurativa: transient clinical efficacy in seven consecutive patients. J Am Acad Dermatol. 2007;56:624-628.
11/30/2015 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Tzellos T, Zouboulis CC, Gulliver W, et al. Cardiovascular disease risk factors in patients with hidradenitis suppurativa: a systematic review and meta-analysis of observational studies. Br J Dermatol 2015 [Epub ahead of print].
- Reviewer: Michael Woods, MD
- Review Date: 06/2016
- Update Date: 11/30/2015