Hidradenitis Suppurativa is also referred to as HS. This skin disease causes painful bumps beneath the skin of those dealing with the sometimes debilitating disorder. The bumps normally occur in the hair roots of the flesh near the sweat glands. There is no known cure for Hidradenitis Suppurativa, but there are treatments that can cause the flares to be fewer and farther between. The doctors involved in HS cases are usually dermatology, infectious disease, and wound care physicians. The team of doctors work together.
The majority of experts believe that HS bumps are the result of blockages in hair follicles on the body. Thus, they can occur anywhere there is hair:
- Arm pits
- Between the buttocks
Flares are also common to appear on the inner thighs and beneath and between the breasts of women (especially if obesity is an issue).
The bumps that occur with Hidradenitis Suppurativa can easily get infected, and pockets filled with pus beneath the flesh that smell quite unpleasant can occur. When the pressure is released from the bump, the smell releases as well. It’s common for darkened scars to be left behind where the bum was. To prevent a recurrence of the flare it is essential to seek out medical treatment.
Since HS is incurable, a patient may clear up one flare and find that the flare has channeled to another area of their flesh. The disorder can create a very aggravating state of mind and drain the patient emotionally. If you have Hidradenitis Suppurativa, be sure that you seek out a support system. Quite often, the only people who can truly understand the humiliation and the hindrance that come with coping with HS.
There are a number of groups on social media that can give you advice because they have been where you are. Others may be where you are, but need the same advice you do. Many men and women alike have found a family within these support groups who can give you the advice needed to assist you with working through the gamut of emotions that may flood you while coping with this skin condition.
What Causes Hidradenitis Suppurativa?
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Doctors don’t know what causes HS. The belief is that the gene is in the body of the patient and something environmental causes it to trigger. When hair follicles get blocked, that is when the skin issues start. Initial signs and symptoms of HS are typically in the late teens to early-twenties.
The disorder hits women more than it does men. It’s more common in people who are overweight or have a heavy smoking habit. Approximately one-third of all people who get a diagnosis of HS also have a family member who has been diagnosed, making it genetically hereditary. A great number of patients have/had severe acne as well.
There are several things that scientists have determined do not trigger HS:
- You cannot get HS from poor hygiene
- There is no proven relationship between the usage of deodorant and powder.
- Shaving your armpits cannot trigger HS.
- You can’t “catch” HS nor can you pass it on to another person.
The initial warning sign of HS is often one minute bump that swells and becomes red and painful. The bump can linger for day, sometimes months. Recurrences of flares in the same spot are not uncommon. These itchy bumps can evolve into stinky pus pockets that leak, especially when found on the breasts. The flares may occur in one spot on your body, or they may channel and appear in several parts of the body at once.
The bumps can go deep and create an actual wound when they burst, depending on how much of the tissue gets infected. The deep wounds will turn into scars and pits on the flesh. If the HS outbreaks are tunneled (or channeled) together by sinus tracts, the flares experienced will more often than not be in more than one place on the body at the same time.
In severe cases of HS, flares linger and sometimes never fully heal. This is when a flare evolves into a full-blown wound rather than a bump. At this point, patients normally have a team of doctors including infectious disease, wound care, dermatology, and primary.
Receiving an Official Diagnosis
The first step in diagnosis will be the doctor checking your skin over your entire body. The diagnosis will be based on the location of the flares, if there are pockets and how deep they are, and how often the flares occur according to you (as the patient).
Prior to your appointment with a specialist, you may want to already have the answers to these questions written out:
- When did your initial symptoms start?
- Do your flares hurt?
- Is this the first time you’ve had this issue?
- Do you have any immediate family with the same problem?
There aren’t any tests that diagnose HS. It is, quite often, a process of elimination that leads to a diagnosis. The doctor will take a pus sample or a biopsy and send it for lab testing in order to rule out infections such as MRSA.
Questions You Should Ask Your Doctor
- What stage is my hidradenitis suppurativa?
- What treatment do you recommend for my individualized case?
- Are antibiotics necessary for me? Are there any other medications I need?
- What are the side effects of the prescriptions you have given me?
- Is there a chance that I will need surgery?
- Are there any lifestyle changes that I need to be aware of so that I can improve my condition?
- Do you advise a weight loss program?
- If my current symptoms worsen should I call your office?
- Will my HS go into remission?
Treatment for HS
The treatment that you receive will depend upon the severity of your HS. Treating your flares can often be a system of trial and error while your physician works with you to find what works best for you flares and your body.
- If you have a mild flare, you can try warm compresses at home. Get a clean face towel and run it under water as hot as you can stand and then place it on the flare for approximately ten minutes.
- If you’re experiencing pain and inflammation, you can take NSAIDs (non-steroidal anti-inflammatory drugs). NSAIDs are available OTC. Ask your doctor which NSAID is best for you. The common ones are:
Multiple Forms of Antibiotics
Antibiotics are the medications that the doctor will give you to ward off any infection that may be setting in, especially if your flare has evolved into an open wound (no matter how small). Antibiotics can be administered in many different forms, such as:
One, or a combination, of these antibiotics can work to ease the symptoms of HS and help to suppress new flares. There are several oral antibiotics that your specialist may give you. Most of the time the starter antibiotic will be either minocycline or doxycycline. The medicine is taken daily for anywhere from eight up to twelve weeks. If there is no chance in your condition, then the doctor may change you to a combo treatment of clindamycin and rifampin.
This medication can be injected directly into the flare, working to calm inflammation, deliver pain relief, and shrink swelling. The injections can be administered once a month for no more than three months. If your HS is extreme, you may be give and prescription for oral steroids.
Retinoid medication comes in the form of a pill. Acitretin and isotretinoin are both retinoids. They can improve the more severe flares that come with late stage Hidradenitis Suppurativa.
Biologics are administered via a shot either in your doctor’s clinic, or at home. In rare cases biologics have to be given through an IV, and thus have to be administered either in the hospital or at a clinic. Biologics jump start your body’s natural ability to battle against germs. The type of biologics include:
Biologics are beneficial at clearing up HS for longer than most medications, but the side effects from them can be pretty serious. They should only be used in the most severe stages of HS and under the watchful eye of a medical professional.
Surgery Used as an HS Treatment
When flares go deep into the tissue there are alternative procedures that can be used to assist the patient. If the problems are concentrated in one small area the doctor can lance them by cutting a small slit in the pocket of pus to drain it/them. This delivers short-term relief from the pain and pressure that patients struggle with.
There is another procedure that is called deroofing. The patient is given anesthetic and the surgeon (usually a plastic surgeon) will remove the sweat glands and hair follicles, turning painful flares into one smooth scar that will not cause discomfort to the patient. The road to complete healing takes approximately eight to twelve weeks. If the patient is immune suppressed due to other medical issues such as diabetes, the healing time can take a bit longer. If infection becomes an issue, this will slow the healing as well.
It is very important to remember that even if the bumps are not weeping and leaking, infection can still set in. The closed bumps are actually more prone to cellulitis than the open bumps. Once cellulitis sets in, Sepsis can be very close behind. This is also true if you have had a deroofing procedure. The areas where they are commonly done are the dark and moist places on our bodies (armpits, groin, buttocks, and inner thigh). It is of utmost importance to follow the doctor and wound care expert’s directions on cleaning and dressing your surgical site.
Surgery is a viable option for HS patients with long-lasting cases but some people still experience recurrences of the flares. For this reason, a solid support system is a must. It can be mentally agitating and physically draining to deal with this disease alone.
Author Bio: Jeff Oescher worked for over 6 years as an orthopedic clinical associate and case technician. He now works as a medical writer for Vohra Wound Physicians, a national wound care physician group.