Hidradenitis Suppurativa (HS)

What is Hidradenitis Suppurativa (HS)?

HS is a chronic inflammatory condition that involves small painful cysts and abscesses that form underneath the skin near hair follicles. They usually form around the groin, bottom, breasts and armpits.

What Are The Causes of Hidradenitis Suppurativa (HS)?

The exact cause of Hidradenitis Suppurativa (HS) is not fully understood, but it is believed to involve a combination of genetic, environmental, and immune system factors. Some potential causes and contributing factors to HS include:

• Genetics: There appears to be a genetic predisposition to HS, as it tends to run in families. Certain genetic variations may increase the likelihood of developing the condition. However, the inheritance pattern of HS is complex, and multiple genes may be involved.
• Hormonal Factors: Hormonal changes may play a role in the development or worsening of HS. Fluctuations in hormone levels, particularly androgens (male hormones), may influence the severity of symptoms in some individuals. HS often begins after puberty, suggesting a hormonal influence.
• Immune System Dysfunction: Dysregulation of the immune system is thought to play a central role in the development of HS. The condition is characterized by chronic inflammation and an abnormal immune response within the hair follicles and sweat glands. Immune system dysfunction may contribute to the formation of abscesses, sinus tracts, and scarring seen in HS.
• Blockage of Hair Follicles: HS is thought to start with blockage and inflammation of hair follicles, particularly in areas where skin rubs together, such as the groin, armpits, and buttocks. This blockage can lead to the formation of painful nodules, abscesses, and sinus tracts.

What Are The Signs And Symptoms of Hidradenitis Suppurativa (HS)?

Signs and symptoms vary per person. Some examples include:

• Painful Lesions: One of the hallmark symptoms of HS is the development of painful, inflamed lesions in areas where skin rubs together, such as the armpits, groin, buttocks, and under the breasts. These lesions may initially appear as small, tender bumps or nodules.
• Abscesses: Over time, the inflamed bumps can progress to form larger, painful abscesses or boils beneath the skin. These abscesses may fill with pus and eventually rupture, leading to drainage of foul-smelling fluid.
• Sinus Tracts: In some cases, the abscesses may develop interconnected tunnels beneath the skin called sinus tracts. These tunnels can extend deep into the tissue and may be associated with chronic drainage and scarring.
• Scarring: As the condition progresses, repeated inflammation and healing cycles can lead to the formation of scar tissue in the affected areas. The scarring may cause skin thickening, discoloration, and the formation of hardened plaques.
• Pain and Discomfort: The lesions, abscesses, and sinus tracts associated with HS can cause significant pain, tenderness, and discomfort, particularly during flare-ups or periods of active inflammation.
• Discharge and Odor: The drainage from HS lesions may have a foul odor due to the presence of bacteria and dead tissue.
• Recurrent Flare-Ups: HS tends to be a chronic condition characterized by periods of exacerbation (flare-ups) alternating with periods of remission. Flare-ups can be triggered by various factors, including hormonal changes, stress, friction, and certain lifestyle factors.
• Restricted Mobility: In severe cases, the presence of large, painful lesions and scar tissue may limit mobility and range of motion, particularly in areas such as the groin or underarms.

What Are The Risk Factors of Hidradenitis Suppurativa (HS)?

• Age and Gender: HS typically begins after puberty and is most common in young adults. It often affects individuals between the ages of 20 and 40. Additionally, HS is more common in women than in men.
• Genetics: There appears to be a genetic predisposition to HS, as it tends to run in families. Having a close relative, such as a parent or sibling, with HS increases the risk of developing the condition.
• Hormonal Factors: Hormonal changes may play a role in the development or worsening of HS. Fluctuations in hormone levels, particularly androgens (male hormones), may influence the severity of symptoms in some individuals. HS often begins or worsens after puberty, suggesting a hormonal influence.
• Obesity: Obesity is a significant risk factor for HS. Excess weight and obesity can lead to friction and irritation in skin folds, which may exacerbate the inflammation and formation of HS lesions. Metabolic syndrome, a cluster of conditions including obesity, high blood pressure, high blood sugar, and abnormal cholesterol levels, is associated with an increased risk of HS.
• Smoking: Smoking has been identified as a risk factor for HS. It is believed that smoking may contribute to inflammation and impaired immune function, which can exacerbate HS symptoms and make the condition more difficult to manage.
• Other Health Conditions: Certain underlying health conditions, such as inflammatory bowel disease (IBD), may be associated with an increased risk of HS. Having these conditions may also worsen the severity of HS symptoms.

How is Hidradenitis Suppurativa (HS) Diagnosed?

Diagnosing Hidradenitis Suppurativa (HS) typically involves a combination of medical history, physical examination, and sometimes additional tests.

• Medical History: The healthcare provider will begin by taking a detailed medical history, including asking about the patient’s symptoms, their onset, duration, severity, and any factors that worsen or alleviate them. They may also inquire about family history, previous treatments, and any underlying health conditions that may be associated with HS.
• Physical Examination: A thorough physical examination is essential for diagnosing HS. The healthcare provider will examine the affected areas, such as the armpits, groin, buttocks, and under the breasts, for characteristic signs of HS, including inflamed nodules, abscesses, sinus tracts, and scarring. They may also assess the severity and distribution of lesions and evaluate for any complications, such as infection or cellulitis.
• Diagnostic Criteria: Diagnosis of HS is based on specific clinical criteria established by organizations such as the International Hidradenitis Suppurativa Foundation (HSF). These criteria include the presence of recurrent, painful, inflamed nodules or abscesses in characteristic locations and the presence of sinus tracts or scarring.
• Biopsy: In some cases, a skin biopsy may be performed to confirm the diagnosis of HS and rule out other conditions.

What Are Possible Treatments For Hidradenitis Suppurativa (HS)?

We have many different ways to treat HS depending on how severe the condition is. These treatments can range from intralesional steroid injections, biologic injections on a period basis, and various medications, including both oral and biological, that can help regulate the condition. Often times we can also do minor or major surgeries that can remove the sinus tract and the HS lesion. These procedures include de-roofing, CO2 laser treatments, or wide excisions.

Are There Preventative Steps or Measures To Avoid Hidradenitis Suppurativa (HS)?

While Hidradenitis Suppurativa (HS) cannot always be prevented, there are steps individuals can take to reduce the risk of developing or exacerbating the condition.

• Maintain a Healthy Weight: Obesity is a significant risk factor for HS, so maintaining a healthy weight through a balanced diet and regular exercise may help reduce the risk of developing the condition.
• Practice Good Hygiene: Keeping the skin clean and dry can help prevent bacterial colonization and reduce the risk of infection. Gentle cleansing with a mild soap and water can help remove excess oils, sweat, and debris from the skin.
• Avoid Tight Clothing: Wearing tight clothing or synthetic fabrics can increase friction and irritation in skin folds, potentially exacerbating HS symptoms. Opt for loose-fitting, breathable clothing made of natural fibers like cotton whenever possible.
• Quit Smoking: Smoking has been identified as a risk factor for HS and may worsen symptoms. Quitting smoking can help reduce inflammation, improve immune function, and promote overall skin health.
• Manage Stress: Stress can exacerbate inflammatory skin conditions like HS, so finding effective stress management techniques such as mindfulness, meditation, yoga, or counseling may help reduce the frequency and severity of flare-ups.
• Avoid Shaving Irritated Skin: Shaving over inflamed or irritated skin can exacerbate HS symptoms and increase the risk of infection. Be cautious with hair removal methods such as waxing or depilatory creams, as these can sometimes trigger or worsen HS lesions. Consider alternative hair removal methods or consult a dermatologist for guidance.
• Manage Underlying Health Conditions: Certain underlying health conditions, such as metabolic syndrome or inflammatory bowel disease (IBD), may be associated with an increased risk of HS. Managing these conditions effectively through lifestyle modifications and medical treatment may help reduce the risk of developing HS or improve existing symptoms.
• Seek Early Treatment: If you notice any signs or symptoms of HS, such as painful nodules, abscesses, or sinus tracts, seek prompt medical attention for diagnosis and treatment. Early intervention can help prevent complications and improve outcomes.
• Follow Treatment Recommendations: If diagnosed with HS, it’s important to follow your healthcare provider’s treatment recommendations and attend regular follow-up appointments. Adhering to treatment plans can help manage symptoms, reduce the frequency of flare-ups, and prevent complications.

What Are The Risks If Hidradenitis Suppurativa (HS) Is Left Untreated?

• Chronic Pain and Discomfort: HS lesions can cause significant pain, tenderness, and discomfort, especially during flare-ups. Without treatment, these symptoms may persist and worsen over time, impacting quality of life and daily activities.
• Recurrent Infections: HS lesions are prone to bacterial colonization and infection, leading to the formation of abscesses, cellulitis, and systemic infections. Untreated infections can spread to surrounding tissues or other parts of the body, potentially causing serious complications such as sepsis.
• Scarring and Fibrosis: Chronic inflammation and healing cycles in HS can lead to the formation of scar tissue in the affected areas. Over time, extensive scarring and tissue damage may occur, leading to loss of skin elasticity, functional impairment, and disfigurement.
• Fistulas and Sinus Tracts: Untreated HS can result in the formation of interconnected tunnels beneath the skin called sinus tracts. These sinus tracts may extend deep into the tissue and connect multiple HS lesions, leading to chronic drainage, recurrent infections, and the risk of developing fistulas (abnormal connections between organs or tissues).
• Psychological Impact: Living with untreated HS can have a significant psychological impact on affected individuals. The chronic nature of the condition, its associated symptoms, and its effect on physical appearance and quality of life can contribute to psychological distress and impaired well-being.
• Decreased Quality of Life: Untreated HS can significantly impair quality of life by causing pain, discomfort, mobility limitations, and emotional distress. Individuals may experience difficulty performing daily activities, engaging in social interactions, and maintaining employment or relationships.
• Worsening Symptoms: Without appropriate treatment, HS symptoms are likely to worsen over time, with frequent and severe flare-ups, increased lesion size and number, and progressive tissue damage. Delaying treatment may make it more challenging to manage symptoms and prevent complications in the long term

Are There Other Related Conditions To Hidradenitis Suppurativa (HS)?

• Acne: Acne is a common skin condition characterized by the formation of comedones, papules, pustules, and nodules on the face, chest, and back. While distinct from HS, both conditions involve abnormalities in the hair follicles and are associated with inflammation and immune dysregulation.
• Obesity and Metabolic Syndrome: Obesity is a significant risk factor for HS and is associated with metabolic syndrome, a cluster of conditions including abdominal obesity, high blood pressure, high blood sugar, and abnormal cholesterol levels. Metabolic syndrome may contribute to the development and severity of HS.
• Inflammatory Bowel Disease (IBD): Some studies have found an increased prevalence of HS among individuals with IBD, including Crohn’s disease and ulcerative colitis. While the exact relationship between HS and IBD is not fully understood, they may share common genetic and immune-mediated factors.
• Polycystic Ovary Syndrome (PCOS): PCOS is a hormonal disorder characterized by irregular menstrual cycles, hyperandrogenism (elevated levels of male hormones), and polycystic ovaries. Women with PCOS may be at increased risk of developing HS, possibly due to hormonal imbalances and increased androgen levels.
• Diabetes Mellitus: Diabetes mellitus, especially type 2 diabetes, has been identified as a potential risk factor for HS. Both conditions are associated with obesity, insulin resistance, and chronic inflammation, which may contribute to the development or exacerbation of HS.
• Depression and Anxiety: Living with a chronic skin condition like HS can have a significant psychological impact, leading to feelings of depression, anxiety, stress, and impaired quality of life. Mental health conditions are common among individuals with HS and may require additional support and management.

Key Takeaways About Hidradenitis Suppurativa (HS)

1. HS is a chronic inflammatory condition that involves small painful cysts and abscesses that form underneath the skin near hair follicles. They usually form around the groin, bottom, breasts, and armpits.
2. Signs and symptoms include painful lesions, abscesses, sinus tracts, scarring, pain/discomfort, discharge and odor, and restricted mobility.
3. Seek Early Treatment: If you notice any signs or symptoms of HS, such as painful nodules, abscesses, or sinus tracts, seek prompt medical attention for diagnosis and treatment. Early intervention can help prevent complications and improve outcomes.
4. We have many different ways to treat HS depending on how severe the condition is. Treatment options can include injections, medications, and minor or major surgeries.

Recommended Next Steps

Ask your dermatologist if you believe you may have HS and get evaluated for every treatment and prevention