Hidradenitis suppurativa

The cause of HS is not well understood. It is thought to start with blockage of the hair follicles. When the fluid within cannot escape, the hair follicles swell up and burst, causing the area to become inflamed or form abscesses.

A common misconception is that HS is related to hygiene. Poor hygiene does not cause HS.

Things that can lead to HS include:

• Hormones may be involved in the control of apocrine sweat glands and might play a part in the condition. HS may be worse before menstrual periods. Some patients may benefit from hormone treatments (see below).
• Bacteria (germs) that normally live on the skin may become trapped in the blocked gland or hair follicle producing inflammation.
• An over-active immune system is involved causing inflammation and so treatments that reduce immune system activity may be helpful (see below).
• Smoking is linked with HS (up to 60% of people affected by HS are smokers), but the condition can also affect non-smokers.
• HS can affect people of normal weight but is more common in people who are overweight or obese. Reducing weight through lifestyle changes (such as improving the diet) and medications which are licensed for weight loss may improve HS symptoms: for example, semaglutide and tirzepatide.

What other conditions are associated with hidradenitis suppurativa?

• HS can contribute to developing depression and anxiety. If you feel worried, anxious, embarrassed or unhappy, It is important to speak with a healthcare professional, such as your GP.
• There may be a link with acne, dissecting scalp cellulitis (scarring and inflammation of the scalp) and pilonidal sinus (a chronic abscess at the top of the buttock crease).
• HS is also linked to other medical problems such as high cholesterol, high blood pressure and diabetes. These do not cause HS, but your healthcare professional may check your weight, blood pressure and carry out blood tests for sugar and cholesterol levels.
• In some people affected by there is a connection with inflammatory bowel disease such as Crohn disease and ulcerative colitis. If you experience bowel symptoms such as persistent diarrhoea, blood in the stools, unexplained weight loss or persistent abdominal pain, it is important to seek medical attention.
• There is also a link with inflammatory arthritis, so seek medical attention for persistent joint pain or swelling. 

Is hidradenitis suppurativa hereditary?

Yes, HS runs in the families of about one third of those affected by the condition.

Is hidradenitis suppurativa contagious?

No, it cannot be passed on to another person at all.

HS abscesses are usually painful. The pain may make it difficult to perform regular activities such as sitting or walking. Discharge of pus can be a problem and may require daily dressings.

In the early stages of HS, there are a mixture of blackheads, pus spots or red lumps which look like boils or cysts (also known as abscesses). In the later stages of HS, tunnels (also called sinus tracts or fistulas) may form under the skin that leak pus with wounds that may not heal easily. As time goes by, more and more scarring may appear.

Images DermNetNZ.

The diagnosis is usually made by a healthcare professional examining the area, the patient’s history and symptoms described by the patient. There is no specific test for this diagnosis. The condition is often misdiagnosed initially as an infection or inflammation of the hair follicles. This can result in delayed treatment and progression of the condition with scarring.

Can hidradenitis suppurativa be cured?

No, it usually persists for many years but can become inactive eventually. Treatment usually helps the management of symptoms and reduces the amount and severity of flares.

Can pregnancy affect hidradenitis suppurativa?

The impact of pregnancy on HS activity varies. In most cases, HS is unchanged or improves during pregnancy, however there can be more flares soon after delivery.

How can hidradenitis suppurativa be treated?

Treatment is tailored to each individual. In general terms, early HS is usually treated with medication, whereas more longstanding and severe HS may benefit from both medication and surgery, especially if multiple areas are affected.

What treatment is available for a sudden flare of HS, such as a new painful abscess?

Treatment is tailored to each individual. In general terms, early HS is usually treated with medication, whereas more longstanding and severe HS may benefit from both medication and surgery, especially if multiple areas are affected.

What treatment is available for a sudden flare of HS, such as a new painful abscess?

• A warm flannel applied to the affected area or taking a bath may encourage drainage of pus.
• Painkillers, such as non-steroidal anti-inflammatories (NSAIDs), can help with the pain and inflammation.
• A topical steroid (cream/lotion) can sometimes reduce the inflammation (redness, swelling and pain).
• A course of antibiotics may be helpful.
• Surgical treatment to lance the boil (incision) and drainage of the pus can reduce pain and provide temporary improvement.
• A steroid injection into the boil is sometimes considered by dermatologists.

Medical treatment to try to prevent flares of HS:

Surgical treatment:

Wound treatment: 

The following measures may be beneficial:

• If relevant, try to lose weight and stop smoking.
• Avoid tight clothing and tight underwear.
• Use antibacterial or antiseptic soap or shower gel.
• Avoid shaving affected areas, such as underarms.
• Try to reduce anxiety and stress levels.
• Consider joining a support group

HS Uncovered: Patient Perspectives on the Impact of Living With Hidradenitis Suppurativa: Results From the Global ‘HS Uncovered’ Burden of Disease Survey.

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