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Hidradenitis Suppurativa

(Acne Conglobata; Acne Inversa [AI]; Apocrine Acne; Apocrinitis; Fox-Den Disease; HS; Hydradenitis Suppurativa; Pyodermia Significa Fistulans; Velpeau's Disease; Verneuil's Disease)
  • Definition

    Hidradenitis suppurativa (HS) is an inflammatory condition of the hair follicle. Recurrent, inflamed nodules and cysts form in the armpits and groin. These may also be found under the breasts, and around the nipples and anus. Less commonly other areas of the body can be affected.
    Sweat Gland
    Nuclus factsheet image
    Copyright © Nucleus Medical Media, Inc.
  • Causes

    The hair follicle becomes blocked causing inflammation. The blockage may lead to absesses, infection, or scarring. The sweat glands may also become inflammed.
    Menstruation in women, weight gain, stress, hormonal changes, heat, and excesive perspiration may trigger the condition.
  • Risk Factors

    HS is more common in women than in men. Other factors that increase your chance of HS include:
    • Family history
    • Current or history of smoking
    • Obesity
    • Diabetes
    • Metabolic syndrome—a condition marked by elevated blood pressure, cholesterol, blood glucose, and body weight
    • Lipid disorders, including low HDL (good) cholesterol levels and/or high triglycerides
  • Symptoms

    HS usually presents at puberty, but may occiur at any age after that. It may cause:
    • Burning, itching, or painful lumps in the armpits, groin, under the breasts, around the nipples or anus, and other involved areas
    • Pus leaking from openings in the lumps
    • Scarring
    There are 3 stages of the condition:
    • Harley stage 1: single or multiple abscesses without sinus tracts or scarring
    • Harley stage 2: recurrent single abscesses or multiple widely separated lesions with sinustract formation and scarring
    • Harley stage 3: multiple interconnected tracts and abscesses are observed across the entire area with diffuse or near-diffuse involvement
  • Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done. In most cases, the doctor will be able to make a diagnosis by looking at the abscesses and nodules.
    Sometimes cultures will be done of drainage. Occasionally other blood tests or ultrasond of the lesions is done.
  • Treatment

    The treatment with depend on the stage of the disease. Talk with your doctor about the best treatment plan for you. Options may include one or more of the following:
    Home Care and Lifestyle Changes
    You may be able to improve the condition by taking these steps:
    • Use warm compresses to relieve discomfort and promote abscess drainage.
    • Avoid shaving if your skin becomes irritated.
    • Wear loose-fitting, nonsynthetic clothing.
    • Use antibacterial soap.
    • Try to avoid heat and humidity.
    If you smoke, talk to your doctor about finding a program to help you quit. It is also important to maintain a healthy weight and eat a healthful diet. If you need help losing weight, consider talking to a dietitian who can help you with meal planning.
    Your doctor may prescribe one or more medications depending on the severity of your HS.
    Your doctor may recommend oral or topical antibiotics.
    Corticosteroids and Other Immunosuppresants
    Corticosteroids may help improve symptoms. These can be taken by mouth, applied to the skin, or injected into the area.
    Other medications called biologics, which decrease the bodies immune response, may be used in severe cases. These medications have many risks, so your doctor will carefully weigh the risks and benefits of using these.
    Other Medications
    Hormonal medications, such as oral contraceptives can be used in some cases. At other times, medications called retinoids may be used.
    Small lesions can be treated in the doctor's office. The sores may be cut open and allowed to drain. If your condition is severe, then a wide area may need to be removed. In these cases, a skin graft may be needed.
    Other procedure options include:
    • Laser surgery—uses lasers to remove lesions
    • Cryosurgery—uses cold to freeze lesions
    • Laser hair removal
  • Prevention

    There are no current guidelines to prevent HS.

    American Academy of Dermatology

    Hidradenitis Suppurativa Foundation


    Canadian Dermatology Association


    Hidradenitis suppurativa. EBSCO DynaMed website. Available at: February 1, 2016. Accessed May 9, 2016.

    Hidradenitis suppurativa. National Organization of Rare Diseases website. Available at: Updated 2012. Accessed May 9, 2016.

    Lam J, Krakowski AC, Friedlander SF. Hidradenitis suppurativa (acne inversa): management of a recalcitrant disease. Pediatr Dermatol. 2007;24(5):465-473.

    Shah N. Hidradenitis suppurativa: a treatment challenge. Am Fam Physician. 2005;72(8):1547-1552.

    Fardet L, Dupuy A, Kerob D, et al. Infliximab for severe hidradenitis suppurativa: transient clinical efficacy in seven consecutive patients. J Am Acad Dermatol. 2007;56:624-628.

    11/30/2015 DynaMed's Systematic Literature Surveillance Tzellos T, Zouboulis CC, Gulliver W, et al. Cardiovascular disease risk factors in patients with hidradenitis suppurativa: a systematic review and meta-analysis of observational studies. Br J Dermatol 2015 [Epub ahead of print].

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