Hidradenitis Suppurativa

How to Treat Hidradenitis Suppurativa

Ease your Pain with a Treatment Plan

Hidradenitis suppurativa (HS), also called acne inversus, is a chronic inflammatory skin condition that can cause painful and red lumps underneath the skin. These lumps occur most frequently in areas where the skin rubs together. They can turn into abscesses with subsequent scarring.

What is Hidradenitis Suppurativa?

Mayo Clinic defines hidradenitis suppurativa as, “...a condition that causes small, painful lumps to form under the skin. The lumps usually develop in areas where your skin rubs together, such as the armpits, groin, buttocks, and breasts. The lumps heal slowly, recur, and can lead to tunnels under the skin and scarring.”

HS develops because hair follicles become blocked, which causes bacteria to be trapped. Eventually, inflammation and subsequent rupture occur.

There is no known cause of HS. However, certain factors can increase the likelihood of the development of HS, such as genetics, the environment, and hormonal changes.

Hidradenitis Suppurativa Treatments

There are a variety of different treatment options available to treat HS. Typically, treatment begins with medications. Surgical interventions may be required.

Medication for Hidradenitis Suppurativa

Typically, topical antibiotics are prescribed. Eventually, treatments may intensify, pending on the severity of HS. Medications can also be used together to improve the treatment plan.

  • Topical antibiotics. Mild symptoms may only require an OTC cream or gel. Sometimes, stronger agents are used, and a prescription is required.
  • Oral antibiotics. When topical antibiotics aren’t enough, oral antibiotics may be prescribed. Examples include doxycycline (Monodox), clindamycin (Cleocin), and rifampin (Rimactane).
  • Steroid injections. Occasionally, a steroid called triamcinolone (Kenalog-10 and Aristospan) is injected directly into the bumps.
  • Hormonal therapy. Occasionally, an estrogen prescription can be helpful, especially if the cause is hormonally related.
  • Biologics. These medications can be given via injection or intravenous infusion. Biologics work by disrupting the disease cycle. Examples include adalimumab (Humira) and infliximab (Remicade).
  • Retinoids. When HS is acne-like (acneiform), retinoids can be helpful.

Hidradenitis Suppurativa Surgery

When HS requires surgery, it is typically an in-office procedure. Various procedures can be performed.

  • Incision and drainage (I&D). I&D is a procedure that requires the healthcare provider to make a surgical incision and drain the lesion. It is not uncommon for the lesions to return.
  • Deroofing. This procedure is ideal for recurrent lesions. Deroofing requires the provider to remove the “roof” of the bump. It is then left open so that it can heal on its own.
  • Wide excision. Similar to an I&D, the provider makes a surgical incision, but the incision is larger and wider. It is also left open to heal on its own.
  • Laser surgery. This type of surgery requires that the HS lesions are stable, thus, medications are used initially. Strong lasers are used to vaporize the HS bumps. Unfortunately, it can take up to six months to heal from this procedure.

Self-care for Hidradenitis Suppurativa

Even with the best medications and surgical procedures, adequate self-care is required to improve the symptoms of HS.

Examples of proper self-care for HS include:

  • Using heat to improve the symptoms of HS. A warm water compress can ease the pain - a simple washcloth placed in hot water and applied to the bumps can improve the pain and inflammation. A black tea compress can also be highly effective. The tea bag is prepared as if drinking the tea. The tea should steep for ten minutes then the hot water can be poured onto a washcloth and applied to the bumps.
  • Avoid sweating. Sweating and overheating can worsen the pain associated with HS. As such, it is recommended to reduce sweating. Ways to do this include remaining indoors during the worst heat of the day; sit in a cool area – air-conditioning is a bonus.
  • Use mild antiperspirants and deodorants. Avoid these products if they contain the following ingredients: alcohol, baking soda, parabens, dyes, or fragrance.
  • Wear loose-fitting clothing, especially when HS is flaring. Clothing that rubs on the bumps can worsen symptoms of HS.

The Bottom Line. . .

Though HS can be extremely painful, there are a variety of ways that can successfully treat HS. These include topical antibiotics, oral antibiotics, and other oral medications. In addition, there are many surgical procedures to treat HS.

Sometimes, you may not know what kind of skin condition you have. It's important to get yourself checked out to ensure that you can find a treatment plan.

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