Hidradenitis Suppurativa: Causes & Treatments

Hidradenitis suppurativa is a skin condition that presents a number of challenges for those who have it. Here are the potential causes and treatments, including some encouraging new research on how to battle this condition.

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Hidradenitis suppurativa (HS) is a chronic inflammatory disease marked by the appearance of painful bumps beneath the surface of the skin. Also called acne inversa, the disorder most often occurs in areas where there are creases in skin, such as the armpits and groin. [1]

While this basic definition might sound simple, the disease itself is challenging. It can be difficult to diagnose and treat, and researchers don’t know yet what causes it. For hidradenitis suppurativa sufferers, this adds up to a lot of frustration and disappointment, and the search for a treatment that actually works can take years.

Hidradenitis Suppurativa: What the Research Says

After decades of theorizing it was an infection of apocrine sweat glands (which are localized to areas like the armpit and genital regions, where HS tends to develop), it’s now believed hidradenitis suppurativa is a defect of follicular epithelium—cells in the thyroid gland that are responsible for the production of certain hormones. [2,3,4] What causes this defect, however, remains unknown.

Although there are no established risk factors associated with the disease, there are reports that HS, which affects between 1-2% of the U.S. population, is more prevalent in women than men. There are also studies showing it occurs more frequently in those with African-American ancestry, and it generally doesn’t occur until the onset of puberty. [5]

One of the reasons HS can be difficult to diagnose is that in its early stages, it can resemble other skin conditions like acne or blackheads. [6] People initially notice red bumps on skin, but whereas acne lesions disappear over time, the bumps from hidradenitis suppurativa persist.

These bumps can continue to grow beneath the surface of the skin, becoming pea to marble sized, and eventually develop into painful nodules. In severe cases, these nodules can fill with pus and form tract-like connective tunnels to each other under the skin. When they burst, the result can be thick scarring. In some cases the scars become so hardened they make it more difficult to move, because they limit the range of motion in the arms and legs. [7] It’s important that if you do notice red, sub-surface bumps that don’t go away (especially in the armpit and groin area), you schedule an appointment with a dermatologist as soon as possible to get a diagnosis.

Hidrandenitis Suppurativa Treatments

Once you’ve been diagnosed with hidradenitis suppurativa, the first question is, what can I do about it? Just as there isn’t a known or agreed-upon cause, there isn’t a commonly settled-upon treatment, either. Dermatologists generally try several options before finding one that works for an individual with HS. Often what works for one person doesn’t work for another, making trial-and-error a critical, yet frustrating, part of the process.

The first line of treatment can involve changing some of the outward factors that can make HS worse; namely, losing excess weight to reduce the number of areas where skin rubs together, and wearing loose-fitting clothes to help prevent skin irritation due to friction.

In acute cases of hidradenitis suppurativa, doctors often prescribe antibiotics to prevent or treat any infections that might arise from lesions. [8] Because of retinoic acid’s ability to communicate with skin cells, retinoids can have some value for those who have moderate forms of HS, though more study is needed. [9] The anti-inflammatory action of corticosteroids is effective for some patients, while female sufferers might benefit from antiandrogens and estrogen therapy. [10,11,12] The anti-androgens and estrogen route isn’t one doctors take with male HS patients, as introducing these medications can wreak havoc on male hormones.

One emerging class of treatments is immunosuppressant drugs that impact the body’s inflammatory response. In September 2015, the U.S. Food and Drug Administration approved the immunosuppressant adalimumab (trade name Humira) for the treatment of moderate to severe hidradenitis suppurativa after clinical trials showed it was successful in reducing HS lesions. [13] This is the first FDA-approved treatment for the condition, marking a new and hopeful chapter in the fight against it.

Even more encouraging news, just two months after the approval of Humira for HS, the Journal of the American Medical Association published the results of a small, randomized clinical trial of another immunosuppressant, anakinra (trade name Kineret) on hidradenitis suppurativa. The data showed anakinra could safely and effectively treat the disease. [14] Clearly more research is needed, but it’s another positive step in the right direction.

Can Skincare Help Hidrandenitis Suppurativa?

The answer to questions about whether skincare can help in the management and treatment of hidradenitis suppurativa is yes, but only to a certain extent. Since the majority of HS bumps occur deep within the skin, there’s not much topical treatments can do, at least when it comes to complete relief.

Where skincare can help is in treating some of the surface conditions that can arise as a result of HS. Since it’s an inflammatory condition, redness is common. Beta hydroxy acid (BHA), also known as salicylic acid, is an excellent and gentle anti-inflammatory agent that holds the potential to help reduce redness and surface tenderness when nodules become irritated.

It’s also important to use gentle skincare products in all aspects of your skincare routine to keep the risk of surface irritation to a minimum. That means avoiding products containing high amounts of fragrance and alcohol, as well as harsh scrubs that could cause surface tears on skin, all of which fuels redness and inflammation.

Since scarring is a common and sometimes debilitating result of having HS lesions, it’s also good to practice proper wound care to minimize the risk of developing severe scars. And of course, if the wounds are not responding to over-the-counter treatments, consult your healthcare provider for further options.

While we still have a lot to learn about hidradenitis suppurativa, the good news is that those who have the disease aren’t left without options. Moreover, the research on how to treat—and potentially cure—this condition is ongoing and getting more encouraging. If you think you might have HS, seek out a dermatologist who’s familiar with the condition, discuss all available treatment options with them (including those that are recently-approved), and use gentle, non-irritating skincare products, including a well formulated, gentle BHA exfoliant.

For more information on hidradenitis suppurativa, visit the Hidradenitis Suppurativa Foundation, Inc. website, which has a number of valuable resources available to HS patients.

References Cited

  1. The Mayo Clinic. Diseases and Conditions: Hidradenitis suppurativa. Definition. [Internet] [cited December 2015] Available from: http://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/basics/definition/con-20027334.
  2. Yu CC, Cook MG. Hidradenitis suppurativa: a disease of follicular epithelium, rather than apocrine glands. Br J Dermatol. 1990. 122(6):763-9.
  3. Attanoos RL, Appleton MA, Douglas-Jones AG. The pathogenesis of hidradenitis suppurativa: a closer look at apocrine and apoeccrine glands. Br J Dermatol. 1995. 133(2):254-8.
  4. Jemec GB, Heidenheim M, Nielsen NH. The prevalence of hidradenitis suppurativa and its potential precursor lesions. J Am Acad Dermatol. 1996. 35(2 Pt 1):191-4.
  5. Medscape. Overview: Frequency. [Internet] [cited December 2015] Available from: http://emedicine.medscape.com/article/1073117-overview#a7
  6. The Mayo Clinic. Diseases and Conditions: Hidradenitis Suppurativa. Symptoms. [Internet] [cited December 2015] Available from: http://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/basics/symptoms/con-20027334
  7. The Mayo Clinic. Diseases and Conditions: Hidradenitis Suppurativa. Complications. [Internet] [cited December 2015] Available from: http://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/basics/complications/con-20027334
  8. Medscape. Hidradenitis Suppurativa Medication. Antibiotics, Other. [Internet] [cited December 2015] Available from: http://emedicine.medscape.com/article/1073117-medication#2
  9. Medscape. Hidradenitis Suppurativa Medication. Retinoids. [Internet] [cited December 2015] Available from: http://emedicine.medscape.com/article/1073117-medication#3
  10. Medscape. Hidradenitis Suppurativa Medication. Corticosteroids. [Internet] [cited December 2015] Available from: http://emedicine.medscape.com/article/1073117-medication#4
  11. Medscape. Hidradenitis Suppurativa Medication. Antiandrogens. [Internet] [cited December 2015] Available from: http://emedicine.medscape.com/article/1073117-medication#5
  12. Medscape. Hidradenitis Suppurativa Medication. Estrogen Derivatives. [Internet] [cited December 2015] Available from: http://emedicine.medscape.com/article/1073117-medication#7
  13. PR Newswire. AbbVie’s HUMIRA (Adalimumab) Receives First and Only U.S. Food and Drug Administration Approval for Moderate to Severe Hidradenitis Suppurativa. [Internet] [cited December 2015] Available from: http://www.prnewswire.com/news-releases/abbvies-humira-adalimumab-receives-first-and-only-us-food-and-drug-administration-approval-for-moderate-to-severe-hidradenitis-suppurativa-300141140.html
  14. Tzanetakou V, Kanni T, Giatrakou S, et al. Safety and Efficacy of Anakinra in Severe Hidradenitis Suppurativa: A Randomized CLINICAL Trial. JAMA Dermatol. 2015. 18:1-9.
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