Hidradenitis Suppurativa

What is Hidradenitis Suppurativa?

Hidradenitis suppurativa is a skin condition that causes small, painful bumps to form underneath the skin. These lumps can break open, and tunnels can form under the skin. This condition most commonly affects areas where the skin rubs together, such as the groin, buttocks, breasts, and armpits. Women, smokers, obese individuals, and African-Americans are disproportionately affected by the burden of this disease.

Signs of hidradenitis suppurativa include:

• Blackheads, often appearing in pairs
• Tunnels that form under the skin over time. These wounds are slow-healing and can leak pus or have an odor
• Scarring
• Painful bumps (nodules/abscesses) that appear in areas with hair follicles and oil and sweat glands, or areas where the skin rubs together

Who is a Good Candidate for Hidradenitis Suppurativa Treatment?

For effective treatment, early diagnosis of hidradenitis suppurativa is key. Individuals should see a dermatologist if their condition is painful, scars, flares often, does not improve, returns within weeks of treatment are unresponsive to topical therapy, or appears in several areas of the body.

What to Expect During Hidradenitis Suppurativa Treatment?

There are a variety of treatment options available, which help to control symptoms and prevent complications. These include:

Antibiotic washes/creams: Mild hidradenitis suppurativa may be managed with topical antibacterial cleansers, lotion, and gels that fight infections.

Steroid Injections: A mainstay in the treatment of acute lesions is intralesional Kenalog.

Oral Antibiotics: Minocycline, doxycycline, rifampin, clindamycin, Bactrim, and quinolones are all used to treat moderate-severe hidradenitis suppurativa.

Hormonal drugs: Oral contraceptives, spironolactone, finasteride are sometimes used for chronic disease.

Biologic agents: Humira (adalimumab) subcutaneous injection may be used for moderate to severe disease in patients 12 and older. Other biologics used in our practice include IL-12/23 inhibitors, infliximab, and IL-17 inhibitors. 

Anti-inflammatory drugs: Zinc, dapsone, acitretin/isotretinoin, metformin, prednisone, and methotrexate are less frequently used for recalcitrant disease.

Uncovering tunnels: Also known as unroofing, this involves removing tissues to expose the tunnels beneath the skin.

Punch debridement: Also called limited unroofing, this may be used to remove a single inflamed nodule.

Surgical removal: For individuals with persistent or severe symptoms, surgical removal may be an option. Individual lesions can be treated with Incision and Drainage or Simple Excision. In more extensive disease, all of the affected skin is removed, and a skin graft may be needed to close the wound. It is important to understand that sores may still occur in other areas of the body after surgery.

Mild cases of hidradenitis suppurativa may also be managed with self-care measures. The following may help to relieve discomfort, prevent outbreaks, or speed up healing:

• Follow a daily skincare routine using a gentle non-soap cleanser or recommended benzoyl peroxide or Hibiclens wash. Avoid using washcloths or loofahs on affected areas
• Avoid wearing tight clothing and irritating products such as detergents with perfumes and dyes
• Avoid injuring the skin, including squeezing pimples and aggressive shaving of affected areas
• Avoid tobacco products, which can worsen symptoms
• Proper nutrition and weight loss if obese

Following Hidradenitis Suppurativa Treatment

Hidradenitis suppurativa treatment is meant to improve symptoms and help manage the condition. The length of your treatment and/or downtime will depend on the severity of your condition and your symptoms. Be sure to follow your dermatologist’s specific instructions on how to care for your skin post-treatment. Please do not hesitate to contact our office regarding treatment or post-treatment questions.

Schedule a Consultation

To schedule your hidradenitis suppurativa consultation today, contact HMGS Dermatology. Our skilled team of dermatologists and dermatology specialists is here to help you improve your skin and overall health.