Hidradenitis suppurativa is a chronic (long-term) skin condition caused by blockage of and inflammation around the sweat glands (apocrine glands). These glands are located under your armpits, groin folds and under the breast areas as well. The result is the appearance of painful lumps of pus (boils) that leak and subsequently heal with scarring.
This week is HS awareness week, so we thought we would shed some light on this condition.
There are 3 main stages of HS. For those with skin phototype 6 (African skin) and those of African descent, larger and more productive apocrine glands results in more severe disease. And with redness being masked in pigmented skin. HS can look like inflammation around the hair follicles (folliculitis) or skin infections especially in the early stage of HS. It is really important to diagnose HS early to prevent progression of the condition and scarring.
Who gets HS?
A lot of our HS patients are worried that the condition is contagious and that it is due to poor hygiene. Thankfully, this is not the case at all!
HS is more common in women but we do see men who suffer from it as well. The painful boils typically start appearing around puberty and 30% of say they have a family history of the condition.
Is there a link between HS and other conditions?
HS is also associated with other conditions like very severe acne, metabolic syndrome (diabetes, obesity, high blood pressure and high cholesterol levels) and Crohn’s disease.
How is HS diagnosed?
There is no special test which can confirm the diagnosis of HS.
The diagnosis is made clinically after a thorough history and examination of the areas affected by a Dermatologist. We look for specific skin signs like the presence of multiple blackheads (comedones), thick ropey-looking scars and pus exiting from skin tracts (sinus tracts) under armpits, under the breast, groin folds and buttock or inner thighs.
Skin swabs might be taken if there is severe pain and pus to exclude a secondary infection.
Can you cure HS?
There is no magic pill that can cure HS entirely. HS is a long term (chronic) skin condition and the main aim of treatment is to treat the painful lumps, reduce the frequency of severe flares and prevent progression to permanent scarring.
What treatments are available for HS?
The treatment approach depends on the severity of HS and is specifically tailored for each individual. So it is really important to seek advice from a dermatologist.
• Reduce weight and stop smoking
• Avoid skin trauma and friction by wearing loose and light clothing
• Avoid squeezing the lumps
• Use antiperspirants or absorbent powder to minimise skin breakdown especially in sweaty areas
• Daily gentle skin hygiene routine to reduce smell and avoid secondary infection. We recommend a soap free wash and using an antibacterial cleanser or dilute bleach bath.
• Dressings to open wounds or pus – use absorbent pads and fix it with non-irritating skin tapes.
There are many medical treatments for HS. Here is a list of some of them
• Topical antibiotic lotions
• Steroid injections (for active, painful lumps)
• Anti-inflammatory antibiotics (for a few months at a time)
• Anti-androgen treatment (eg. Spironolactone) – for HS that flares around periods
• Oral retinoids (Vitamin A derived) – these cannot be used if you are pregnant or breastfeeding
• Oral immune-modulating medications
• Biologic injection which target a specific inflammatory pathway in HS. This is available on the Australian Pharmaceutical Benefits Scheme (PBS) for HS patients who meet the criteria this treatment.
There are also surgical treatments for HS which involve
• de-roofing technique to help skin tracts (sinus tracts) heal
• removing recurrent inflamed skin which are resistant to medical treatments
Remember, you are not alone! HS can impact every aspect of life – physically, emotionally, and social ife! So, get diagnosed and get going with treatment and connect with other patients like yourself on social media -FB page: “HS sufferers in Australia” or on MyHSteam
The information contained in this blog post is intended as a guide only and should not substitute seeking medical attention. Please see your healthcare provider for more information.