Hidradenitis suppurativa (hi-drad-uh-NIE-tis sup-yoo-ruh-TIE-vuh) is a chronic skin condition that features pea-sized to marble-sized lumps under the skin. Also known as acne inversa, these deep-seated lumps typically develop where skin rubs together — such as the armpits, groin, between the buttocks and under the breasts.
The lumps associated with hidradenitis suppurativa are usually painful and may break open and drain foul-smelling pus. In many cases, tunnels connecting the lumps will form under the skin.
Hidradenitis suppurativa tends to start after puberty, persist for years and worsen over time. Early diagnosis and treatment of hidradenitis suppurativa can help manage the symptoms and prevent new lesions from developing.
Hidradenitis suppurativa commonly occurs around hair follicles, where many oil and sweat glands are found, such as in the armpits, groin and anal area. It may also occur in areas where skin rubs together, such as the inner thighs, under the breasts or between the buttocks. Hidradenitis suppurativa can affect a single area or multiple areas of the body.
Signs and symptoms of hidradenitis suppurativa include:
- Blackheads. Small pitted areas of skin containing blackheads — often appearing in pairs or a "double-barreled" pattern — are a common feature.
- Red, tender bumps. These bumps, or lesions, often enlarge, break open and drain pus. The drainage may have an unpleasant odor. Itching, burning and excessive sweating may accompany the bumps.
- Painful, pea-sized lumps. These hard lumps, which develop under the skin, may persist for years, enlarge and become inflamed.
- Leaking bumps or sores. These open wounds heal very slowly, if at all, often leading to scarring and the development of tunnels under the skin.
Hidradenitis suppurativa often starts after puberty with a single, painful bump that persists for weeks or months. For some people, the disease progressively worsens and affects multiple areas of their body. Other people experience only mild symptoms. Excess weight, stress, hormonal changes, heat or excessive perspiration can worsen symptoms.
When to see a doctor
Mild cases of hidradenitis suppurativa may be treated with self-care measures. Consult your doctor if the condition:
- Is painful
- Doesn't improve in a few weeks
- Returns within weeks of treatment
- Appears in several locations
- Recurs often
Hidradenitis suppurativa develops when hair follicles become blocked and inflamed. It's not known why this blockage occurs, but a number of factors — including hormones, genetics, cigarette smoking and excess weight — may all play a role.
Hidradenitis suppurativa affects at least 1 percent of the population. Factors that may increase your risk may include:
- Age. Hidradenitis suppurativa most commonly occurs in young adults.
- Your sex. Women are more likely to develop hidradenitis suppurativa than are men.
- Family history. A tendency to develop hidradenitis suppurativa can be inherited.
Hidradenitis suppurativa often causes complications when the disease is persistent and severe. These complications include:
- Scars and skin changes. Severe hidradenitis suppurativa may leave rope-like scars, pitted skin or patches of skin that are darker than normal.
- Restricted movement. Open sores and scar tissue may cause limited or painful movement, especially when the disease affects the armpits or thighs.
- Obstructed lymph drainage. The most common sites for hidradenitis suppurativa also contain many lymph nodes. Scar tissue can interfere with the lymph drainage system, which may result in swelling in the arms, legs or genitals.
- Social isolation. The location, drainage and odor of the sores — singly or in combination — can cause embarrassment and reluctance to go out in public, leading to depression.
You're likely to start by seeing your family doctor. He or she may refer you to a specialist in skin diseases (dermatologist).
Because appointments can be brief, and because there's often a lot to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment and know what to expect from your doctor.
What you can do
Write down all your signs and symptoms and when they first occurred. Record how long the lesions lasted and if any recurred.
Make a list of all medications — including vitamins, herbs and over-the-counter drugs — that you're taking. Note the dosages and directions for each medication on your list, or take the original bottles with you to your appointment.
Also write down questions that you want to ask your doctor. Don't be afraid to ask questions or to speak up when you don't understand something your doctor says. Start with the problems that concern you most.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:
- When did your symptoms start?
- Did they come on suddenly or gradually?
- What did the lesions look like when they started?
- Are your symptoms painful?
- Have your parents or siblings ever had this problem?
- Have you ever had these symptoms before?
Diagnosis can usually be made by examining the affected skin. If pus or drainage is present, your doctor might send a sample of the fluid to a laboratory for testing.
There is no cure for hidradenitis suppurativa. But early treatment can help manage the symptoms and may prevent new lesions from developing.
Your doctor might suggest trying one or more of the following types of medications:
- Antibiotics. Long-term use of antibiotics can help prevent the disease from worsening and might reduce the risk of future outbreaks. These drugs can come in pill form to take by mouth or in a cream or ointment to spread on the affected skin.
- Corticosteroids. Injecting steroid medications directly into the tender nodule can reduce inflammation. Oral steroids, such as prednisone, can also help. But long-term use of prednisone has many side effects, including osteoporosis.
- Tumor necrosis factor (TNF)-alpha inhibitors. Medications such as infliximab (Remicade) and adalimumab (Humira) show promise in the treatment of hidradenitis suppurativa. However, these drugs can increase the risk of infection, heart failure and certain types of cancers.
Surgical and other procedures
For severe or persistent cases or for deep lesions, surgery may be necessary.
- Incision and drainage. Surgical drainage may be an option when the disease involves a single small area. However, this treatment is generally used for short-term relief.
- Uncovering the tunnels. Known as de-roofing, this procedure cuts away the skin and flesh that cover any interconnected tunnels linking separate lesions. However, the disease may still return in the treated area or another area of the body.
- Surgical removal. Surgical treatment of recurrent or severe symptoms involves removal of all involved skin. A skin graft may be necessary to close the wound. Full surgical removal of the affected areas can treat the disease that is present but doesn't prevent the disease from occurring in other areas.
The following suggestions may help relieve discomfort, speed healing and prevent the infection from spreading:
- Apply warm compresses. A warm washcloth or compress can help reduce swelling.
- Keep the affected area clean. Gently wash the affected areas with antibacterial soap. After washing, apply an over-the-counter antibiotic.
- Wear loosefitting clothes. Loose clothes and underwear can help prevent skin irritation, while tight, synthetic clothes may irritate your skin.
- Lose weight. Excess weight increases the number of areas where skin rubs together — for example, between skin folds — causing friction, increased perspiration and bacterial growth. Though weight loss won't cure the disease, it may improve symptoms.
Zinc supplements taken daily may help reduce inflammation and prevent new outbreaks.
Hidradenitis suppurativa can be painful, unsightly and, if the lesions are draining, foul smelling. The ongoing, persistent nature of the disease and the treatment challenges only add to the burden. You might feel embarrassed or anxious about your symptoms and become withdrawn or self-conscious. You may be frustrated or upset by other people's reactions.
Family and friends can help you tremendously as you go through this difficult time. Sometimes, though, that simply may not be enough. A professional counselor may be able to suggest various coping strategies to help you feel better about your situation. You may also find the concern and understanding of other people with hidradenitis suppurativa especially comforting. Online support groups can connect you with other people living with the condition.