What to Know About Hidradenitis Suppurativa, a Lesser-Known Type of Acne
Our take
The conversation around skin health is, thankfully, expanding beyond the familiar territory of acne vulgaris. The recent article highlighting hidradenitis suppurativa (HS) is a welcome addition to this broader dialogue, bringing awareness to a condition often misunderstood and misdiagnosed. It’s a painful reality for many: experiencing persistent, painful bumps and lesions that feel distinctly different from a typical breakout. The fact that this condition is often overlooked, leading to delayed treatment and significant emotional distress, underscores the need for increased education and empathy. Many individuals grapple with invisible illnesses, and understanding the complexities of managing these conditions while navigating daily life is a constant challenge, as explored in [This Is What It's Like to Travel With an Invisible Illness]. The journey toward diagnosis and acceptance is often fraught with frustration, highlighting the importance of patient advocacy and accessible information.
What makes HS particularly poignant is its deeply personal and often isolating nature. It's not simply a cosmetic concern; it’s a chronic inflammatory disease that can affect mobility, mental health, and overall quality of life. The article rightly points to the need for heightened awareness among both patients and medical professionals. It’s crucial to move beyond simplistic diagnoses and embrace a more nuanced understanding of skin conditions that present atypically. Beyond the physical discomfort, there’s a significant psychological toll, echoed in the experiences shared by those managing chronic allergies, where the cure can sometimes feel as debilitating as the symptoms – [I Have Chronic Allergies — and the Cure Is Almost as Bad as the Symptoms]. The intersection of physical and emotional well-being in chronic illness is a critical aspect that deserves greater attention, and the bravery of individuals sharing their personal journeys, like those detailed in [How I Learned to Love My Bumps and Scars From Hidradenitis Suppurativa], helps to normalize these experiences and foster a sense of community.
The rise in awareness surrounding HS also signifies a broader shift in how we approach skin health. It encourages a more holistic perspective, recognizing that skin conditions are often manifestations of deeper systemic issues. This necessitates a collaborative approach, involving dermatologists, primary care physicians, and even mental health professionals. The article’s emphasis on early diagnosis and appropriate treatment is vital, as HS, if left unmanaged, can lead to complications and significantly impact a person’s life. Furthermore, it highlights the importance of self-advocacy; patients need to be empowered to seek second opinions and actively participate in their treatment plans. It’s a reminder that feeling heard and validated by medical professionals is paramount in navigating chronic health challenges.
Looking ahead, the increased visibility of conditions like HS suggests a promising trend: a growing understanding and acceptance of diverse skin experiences. However, challenges remain. Research into effective treatments is ongoing, and accessibility to specialized care can be a barrier for many. The conversation must continue to evolve, focusing not only on medical advancements but also on destigmatizing chronic skin conditions and fostering a more compassionate and inclusive healthcare system. One question worth watching is whether this increased awareness will translate into improved insurance coverage and access to specialized dermatology services for those living with HS and other lesser-known skin conditions.
If you're experiencing painful bumps or lesions forming under the skin, but it feels or looks different from a typical breakout, it could be a sign of hidradenitis suppurativa. This chronic inflammatory skin condition impacts up to two percent of the US population, according to the HS Foundation, although it affects some people more than others. According to a study published in the International Journal of Women's Dermatology in 2021, women are twice as likely to have hidradenitis suppurativa than men, and Black people are three times more likely to have the condition than white people.
Still, hidradenitis suppurativa isn't as well known or talked about as other skin conditions like eczema or psoriasis. Ahead, dermatologists explain hidradenitis suppurativa, the major signs to look out for, and how to get relief.
Experts Featured in This Article
Ife J. Rodney, MD, is a dermatologist and the founding director of Eternal Dermatology + Aesthetics.
Michael Rosenblum, MD, PhD, is a dermatologist, skin immunology researcher, and professor of dermatology at the University of California, San Francisco.
What Is Hidradenitis Suppurativa?
Hidradenitis suppurativa, also known as acne inversa, is a chronic skin disease. "You may get cysts or boils, usually in folded areas of the skin, like the armpits, groin area, or under the breasts," says dermatologist Ife J. Rodney, MD. (Just a heads up: acne inversa is different from the more common acne vulgaris. A good way to think of it is that the former typically affects the deeper layers of the skin, whereas the latter is seen more outwardly through blemishes like pimples.)
How hidradenitis suppurativa manifests depends on a number of factors, but it can often look like bumps or acne cysts, and it can get worse without treatment, according to the American Academy of Dermatology (AAD). When an abscess breaks open, blood and pus leak out. As it heals, a scar will often develop. Patients may develop more abscesses in the same area, and pus-filled tunnels called sinus tracts can form under the skin, Dr. Rodney says.
"Some forms are quite mild and easily treatable, while others require surgery and adequate pain control," says dermatologist Michael Rosenblum, MD, PhD. "It tends to be a relapsing and remitting disease that is all on a spectrum." That means symptoms may flare up and go away for a period of time before resurfacing again.
What Causes Hidradenitis Suppurativa?
While the exact cause of hidradenitis suppurativa is unknown, many experts believe it is linked to blocked hair follicles under the skin, Dr. Rosenblum says. "The blocked hair follicles trap bacteria, which leads to inflammation and rupture." It's unclear why the blockages occur in the first place, although genetics, environment factors, and hormonal changes may play a role.
"For patients with hidradenitis suppurativa, the inflammation doesn't go away and starts to feed on itself — it gets worse and worse," Dr. Rosenblum says, adding that the condition is ultimately "an inability to control the inflammation."
Although the spread of bacteria is a factor with the condition, hidradenitis suppurativa is not contagious. "Many cases can be pretty striking in appearance, but you cannot get hidradenitis suppurativa from another person," Dr. Rodney says. The AAD also notes that hidradenitis suppurativa isn't a sexually transmitted disease or caused by having unclean skin.
Hidradenitis Suppurativa Symptoms
Symptoms of hidradenitis suppurativa can vary, depending on how severe the condition is in a patient, but Dr. Rodney says there are a few common signs to look out for.
Small, pitted areas of skin that contain blackheads
Painful lumps that grow and break open
Abscesses that drain fluid and pus
Itchy abscesses that may have an odor
Abscesses that heal very slowly and happen again over time
With mild hidradenitis suppurativa, you may only have one or a few lumps in one area of the skin, Dr. Rodney says. Moderate cases of hidradenitis suppurativa usually include lumps that form in different areas of the skin, recur, and break open, while severe cases can include widespread lumps, scars, and chronic pain.
How Is Hidradenitis Suppurativa Diagnosed?
Hidradenitis suppurativa is usually a clinical diagnosis, meaning doctors can determine if you have it after a physical exam. "When patients come in, we can usually tell right away whether they have it or not," Dr. Rosenblum says. However, your doctor may do a skin biopsy if they think there's a chance your symptoms could be due to something else, he says.
"Sometimes, the condition can be very mild, where it may just include one or two cysts that come and go — those can be more difficult to diagnose," Dr. Rodney says. "The more severe cases with larger cysts are easier to spot."
Hidradenitis Suppurativa Treatments
While treatment recommendations vary by patient, there are effective therapy options worth considering. Those can include antibiotics to help reduce the amount of bacteria that can contribute to the inflammation, Dr. Rodney says, along with steroids. "We frequently do steroid injections into the cysts to shut down the inflammatory process," she adds. "That's very helpful, especially if you get it injected as soon as the cyst appears versus when it's larger and really painful."
In more severe cases, a biologic (or a medication made from living organisms, like plasma or growth factors, for example) can be used to try to help control the inflammation, Dr. Rosenblum says. Surgery may be needed to remove the lumps and scars.
There are also a few lifestyle tweaks you can make to help with the pain during flare-ups, including wearing loose-fitting clothes, doing your best to avoid heat and humidity, and trying to avoid injuring your skin.
Does Hidradenitis Suppurativa Ever Go Away?
While the treatments above can help manage the condition, "if you have hidradenitis suppurativa, you have it for life," Dr. Rodney says.
Dr. Rosenblum is hopeful that there will be more options for patients in the future, including more effective treatments. However, in 2023, the FDA approved Cosentyx to treat moderate to severe hidradenitis suppurativa, and research is also exploring new targeted therapies. "There's been a real explosion in the science of trying to understand this disease," he says. "Over the next five to 10 years, there should be new therapies."
Korin Miller is a writer specializing in general wellness, health, and lifestyle trends. Her work has appeared in Women's Health, Self, Health, Forbes, and more.Read on the original site
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