What is hidradenitis suppurativa (HS)?

Hidradenitis suppurativa (HI-drad-en-I-tis sup-per-ah-TEE-vah or HS) is a chronic condition of painful bumps and draining sores of the skin.

It usually affects the skin folds, such as the underarms, buttock crease, and groin area. It is sometimes called “acne inversa,” although it is different from acne.

WHAT CAUSES HS?

HS is caused by inflammation inside the body. HS is not an infection and is not contagious. HS is not caused by poor hygiene. HS is more common in girls and African Americans.

WHAT DOES HS LOOK LIKE?

The symptoms range from multiple comedones (“blackheads”) to painful bumps and abscesses that heal with scarring. Painful bumps can go on to form draining tunnels (“sinus tracts”) under the skin. Deep bumps or tracts often leave scars. The tunnels can drain pus or blood, which can cause a bad smell. The bumps usually start after puberty.

HOW IS HS DIAGNOSED?

Diagnosis is made by your doctor examining your skin. Your doctor may check for infection of the skin before making this diagnosis. Other tests are often not necessary.

HOW LONG DOES HS LAST?

The individual bumps and sores may last for weeks or months. They may keep coming back. In most cases, HS is considered a chronic, or long-lasting condition. Each patient is different, and the bumps may get better or worse over time.

WHAT IS THE TREATMENT HS?

While there are many treatment options for HS, it can be very hard to treat. It may take time to find the best treatment plan for each person. Medicines take weeks to months to work. Be patient and do not stop a medication without first discussing with your doctor. There is not currently a “cure” for HS.

  • Prevention:
    Friction can make HS worse. Diet changes and a healthy lifestyle may help reduce skin-on-skin friction through weight loss, and may improve HS in some patients.
  • Topical therapy:
    Topical medicines can be placed directly on the skin of the affected areas. Some of these medicines contain antibiotics, benzoyl peroxide (which can bleach clothes, towels, and bedding), or retinoids (vitamin A creams commonly used for acne). They are often prescribed in combination with each other. Some patients find diluted bleach baths (swimming pool baths) helpful.
    RECIPE FOR BLEACH BATHS (SWIMMING POOL BATHS):

    • 1/4 cup bleach to a half tub of water
    • Soak for 5-15 minutes, 2-3 times a week.
  • Injections:
    Corticosteroids (potent anti-inflammatory medications) can be injected into bumps to help decrease the swelling, inflammation, and pain. Multiple rounds of steroid injections may be needed. Discuss risks and benefits with your physician.
  • Oral antibiotics:
    Antibiotics can be taken by mouth to help improve symptoms. They usually need to be taken for an extended period of time. Some examples of commonly used antibiotics include doxycycline and clindamycin with or without rifampin. Discuss risks and benefits with your physician.
  • Hormonal therapy:
    Girls with HS may notice that their HS changes with their menstrual cycle. Some forms of birth control can help regulate the hormones that make HS worse. A pill called spironolactone can block the hormones that make HS worse. Your doctor can discuss the risks and benefits of hormonal therapy with you, but these medicines are generally considered quite safe for girls with HS.
  • Biologic therapy:
    More severe cases of HS that have not responded to other treatments may benefit from adalimumab (Humira). Adalimumab is a medicine that is injected into the body (a “shot”) to decrease inflammation. The shot is given once a week. It is approved for HS in children 12 years of age and older. Adalimumab has risks and benefits, which should be discussed with your child’s doctor.
  • Oral retinoids:
    Oral retinoid medications like isotretinoin (Accutane) and acitretin are sometimes used to help HS. Your doctor will discuss risks and benefits with you, but the most common side effects are dryness.
  • Pregnancy and HS treatment:
    If you are pregnant, planning pregnancy, or breastfeeding, please discuss this with your doctor as your medication plan may need to be adjusted.

OTHER TIPS:

  • Wear loose, comfortable clothes. Rubbing and friction can make HS worse.
  • Wash affected areas gently. Do not scrub the areas, and always use clean washcloths.
  • Don’t pop the pimples and bumps as this can make them worse. Warm compresses or soaks can help gently drain the bumps.
  • See your dermatologist or other doctor regularly. Avoid having the bumps cut into and drained at emergency rooms, unless you
    are seeing a surgeon specifically for your HS.
  • Healthy eating may improve your HS.
  • For severe pain or a sudden change in the condition, call your doctor.

© 2019 The Society for Pediatric Dermatology