Hidradenitis suppurativa (hi-drad-uh-NIE-tis sup-yoo-ruh-TIE-vuh) is a skin condition that causes small, painful lumps to form under the skin. The lumps can break open, or tunnels can form under the skin. The condition mostly affects areas where the skin rubs together, such as the armpits, groin, buttocks and breasts.
Hidradenitis suppurativa tends to start after puberty. It can persist for many years and worsen over time, with serious effects on your daily life and emotional well-being. Medications and surgery can help manage symptoms and prevent complications.
Hidradenitis suppurativa usually appears as one or more red, tender bumps that fill with pus. It most commonly occurs in the armpits (shown), groin, between the buttocks and under the breasts.
Hidradenitis suppurativa can affect one spot or multiple areas of the body. Signs and symptoms of the condition include:
Some people with this condition experience only mild symptoms. Excess weight, stress, hormonal changes, heat or humidity may worsen symptoms. In women, the disease severity may lessen after menopause.
Early detection of hidradenitis suppurativa is key to getting effective treatment. See your doctor if your condition:
If you've already received a diagnosis of hidradenitis suppurativa, keep in mind that the warning signs of a disease flare are often similar to those that occurred originally. Also pay attention to any new signs or symptoms. These may indicate either a flare or a complication of treatment.
You may need to see a specialist in skin conditions (dermatologist) or a surgeon for long-term care.
The exact cause of hidradenitis suppurativa isn't known. It develops when hair follicles in the skin become blocked. Experts think it could be connected to hormones, inherited genes and immune system problems. Smoking, excess weight and metabolic syndrome also might play a role.
Hidradenitis suppurativa is not caused by an infection or being unclean, and it can't be spread to other people.
Factors that increase your chance of developing hidradenitis suppurativa include:
Persistent and severe hidradenitis suppurativa often causes complications, including:
Your doctor will ask you about your signs and symptoms, examine your skin and take your medical history.
No laboratory test is available to diagnose hidradenitis suppurativa. But if pus or drainage is present, your doctor might send a sample of the fluid to a laboratory for testing. This can help rule out other conditions, such as an infection.
Treatment with medications, surgery or both may help control symptoms and prevent complications. No single option has been proven to be completely reliable, and research continues to determine the best combination. Talk with your doctor about the risks and benefits of the various treatment options and developing an approach tailored to your situation.
Expect to have regular follow-up visits with your dermatologist or a multidisciplinary health care team that can provide the comprehensive care often required by people with hidradenitis suppurativa.
Your doctor might prescribe one or more of the following types of medications:
Surgical options include:
More studies of surgical options are needed to improve hidradenitis suppurativa care. In particular, good-quality clinical trials are needed to evaluate the timing or surgery and type of surgical procedure. Other interventions being studied are topical antiseptics, novel biological therapies and further study of adalimumab.
Mild hidradenitis suppurativa may be treated with only self-care measures. But self-care is also an important complement to any medical treatment you may be getting. The following suggestions may help relieve discomfort, speed healing or prevent outbreaks:
Follow a daily skin care routine. Gently wash your body with a nonsoap cleanser such as Cetaphil. It may help to use an antiseptic wash such as chlorhexidine 4% when showing. First try it once a week, then increase usage up to once a day if your skin tolerates it well.
When washing, avoid using washcloths, loofahs or other items on affected areas, as they can irritate skin. Then apply an over-the-counter antibiotic cream or a cream containing the antimicrobial benzalkonium chloride. It might also help to apply extra absorbent powder or zinc oxide.
Manage your pain. Gently applying a wet, warm washcloth, tea bag or other sort of compress can help reduce swelling and ease pain. Keep it on for about 10 minutes.
Ask your doctor to recommend the most appropriate pain reliever. And talk with your doctor about how to properly dress and care for your wounds at home.
One of the greatest challenges of living with hidradenitis suppurativa may be coping with pain and embarrassment. Painful sores might affect your sleep, mobility or sex life. If the sores are draining pus, they can smell, despite good self-care. You might feel anxious and become withdrawn, self-conscious or depressed.
Try to find support among your family and friends. You may also find the concern and understanding of other people with hidradenitis suppurativa comforting. Ask your doctor for a referral to a mental health professional or contact information for a support group.
You may start by seeing your primary care doctor. He or she may refer you to a doctor who specializes in treating skin diseases (dermatologist). Depending on the severity of your condition, your care may also involve specialists in colorectal surgery, plastic surgery or digestive diseases (gastroenterology).
Here's some information to help you get ready for your appointment.
Before your appointment make a list of:
For hidradenitis suppurativa, some basic questions to ask your doctor include:
Your doctor is likely to ask you a number of questions, such as: