Last updated: June 2024
What is hidradenitis suppurativa?
Hidradenitis suppurativa is a long-term painful condition, which causes boil-like lumps. They may leak pus and cause scarring. It is commonly found under the arms, between the breasts, in the groin and genital area.
Who gets hidradenitis suppurativa?
Hidradenitis suppurativa often begins in puberty. It is more common in women and individuals with skin of colour.
What causes hidradenitis suppurativa?
The cause of hidradenitis suppurativa remains unclear. It is thought that there is an exaggerated inflammatory response to the presence of bacteria trapped in blocked hair follicles in the skin.
Some individuals may have another family member with this condition. Hormones may be involved, and some women notice a flare before their period.
Other factors such as obesity, smoking and stress can play a role. It is not contagious.
What does hidradenitis suppurativa look like?
There may be blackheads (comedones) or red lumps that look like boils (abscesses and nodules). Sometimes the lumps may leak pus. Scarring may form, leading to tunnels under the skin that leak pus.
Figure 1. Hidradenitis suppurativa on underarm – Images reproduced with permission Professor Alan Cooper
How is hidradenitis suppurativa diagnosed?
The diagnosis is usually made clinically after considering an individual’s medical history and symptoms, and examining the areas involved. There is no specific test for hidradenitis suppurativa.
How is hidradenitis suppurativa treated?
Treatment options will vary depending on the individual and their needs.
Lifestyle modifications such as stopping smoking or vaping, aiming for healthy body weight, avoiding tight clothing and reducing stress are recommended.
A sudden flare-up may be managed by painkillers, such as non-steroidal anti-inflammatories, a warm bath or applying a drawing agent to encourage the pus to drain.
Steroid injections into the area or minor surgical procedures may be performed. Simple absorbent dressings can soak up any discharge.
The main method of treating mild disease involves antibacterial washes and topical antibiotics.
To prevent flare ups, long courses of antibiotics can be used. Anti-androgens can be helpful, particularly in women who have flareups before their period. Metformin, a diabetic medication may also be helpful for some individuals.
Biological agents which reduce the abnormal inflammation such as adalimumab and secukinumab may be used. There are some newer agents being trialled.
Often surgery is required and combined with medical treatment. A technique called deroofing is often successful.
Other treatment options may include retinoids (vitamin A-like drugs), photodynamic therapy and laser treatment.
What is the likely outcome of hidradenitis suppurativa?
Hidradenitis suppurativa is not curable but is usually improved with treatment.
The painful and recurrent nature of this disease can be very distressing to the affected individuals and impacts greatly on their quality of life and mental health.
Treatment and control of the inflammation is important to minimise the condition progressing and scarring.
Hidradenitis suppurativa often improves as the individual gets older. Most individuals do not progress to the most severe form of the disease.
| Dr Helen Saunders and Dr Victoria Harris | June 2024 |
| Prof Alan Cooper and Dr Victoria Harris | April 2017 |