Hidradenitis Suppurativa

Causes and Risk Factors of Hidradenitis Suppurativa

Suppurativa - What It Is

Hidradenitis suppurativa (HS) is a chronic and painful skin condition characterized by the inflammation of hair follicles. This condition is believed to be linked to a genetic predisposition that weakens the follicular wall, leading to various symptoms and complications.

Key Characteristics of Hidradenitis Suppurativa:

Common Symptoms: HS typically manifests as.

• Blackheads

• Pimples

• Boils

• Abscesses

• Scarring

Tunnels or sinus tracts that form under the skin

Typical Locations: The lesions commonly develop in areas where skin rubs together, including:

• Armpits

• Underneath the breasts

• Groin

• Inner thighs

• Buttocks

In some cases, lesions may also appear on other parts of the body, such as:

• The abdomen

• The back of the neck

• The chest

• The back

• Behind the ears

Hidradenitis suppurativa can significantly affect a person's quality of life, leading to physical discomfort, emotional distress, and social challenges. Early diagnosis and management are crucial to controlling symptoms and preventing complications.

Causes of Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) involves several interconnected processes that contribute to the formation of its characteristic lesions. Here are the four main factors involved:

Abnormal Skin Cell Structure:

The skin cells lining the hair follicles may exhibit structural abnormalities, leading to a buildup of oil and dead skin cells within the hair follicle.

This abnormality weakens the hair follicle, making it more susceptible to rupturing.

Hormonal Influence:

Hormonal changes can increase oil production in the skin, further contributing to the clogging of hair follicles.

This excess oil plays a significant role in the development of HS lesions.

Inflammation and Boil Formation:

As oil and dead skin cells accumulate, the hair follicle may rupture, resulting in inflammation of the surrounding skin.

This inflammation can lead to the formation of painful boils.

Chronic Inflammation and Tunneling:

Over time, persistent inflammation can cause the skin to develop tunnels (sinus tracts) that extend beyond the initial boil site.

These tunnels can become pathways for fluid drainage and may contribute to scarring.

Understanding these underlying causes is essential for developing effective management strategies for individuals suffering from hidradenitis suppurativa.

Risk Factors for Hidradenitis Suppurativa

While the exact cause of hidradenitis suppurativa (HS) remains unclear, several biological and environmental factors are believed to contribute to its development. Here are the primary risk factors:

Genetics:

Family history plays a significant role, with approximately one in three patients with HS having a relative who also suffers from the condition. Genetic predisposition may influence susceptibility to HS.

Lifestyle Habits:

Obesity: Increased body weight is frequently associated with HS, potentially due to friction and skin folds that can exacerbate the condition.

Smoking: Cigarette smoking has been identified as a risk factor and may worsen the severity of HS.

Age:

HS typically manifests in teenagers and young adults, particularly those in their early 20s. However, it can develop at any age, indicating that younger individuals are more susceptible.

Sex:

Women are significantly more likely to develop HS, with studies indicating that they are three times more prone to the condition compared to men.

Other Medical Conditions:

Many individuals with HS also experience other health issues, which may include:

• Inflammatory bowel disease

• Arthritis

• Depression

Metabolic syndrome, characterized by high cholesterol, high blood pressure, diabetes, and an overall increased risk of cardiovascular disease.

Recognizing these risk factors can aid in the early identification and management of hidradenitis suppurativa, helping patients receive timely care and support.

Triggers of Hidradenitis Suppurativa

Understanding the triggers of hidradenitis suppurativa (HS) can help individuals manage their condition more effectively. Here are the common triggers that may exacerbate HS:

Friction and Sweating:

Activities like exercise can lead to sweating and friction, which may provoke a flare-up. Tight or chafing clothing during workouts can further irritate the skin.

Weather:

Hot and humid conditions, particularly during summer, can worsen HS symptoms for some individuals.

Clothing:

Tight-fitting and non-breathable clothing can aggravate HS. Opting for loose-fitting attire that avoids contact with skin creases can be beneficial.

Weight Gain:

Individuals with a higher body mass index (BMI) are more prone to HS. Weight loss has been shown to improve symptoms and is often a key aspect of HS management.

Alcohol Intake:

Some people report that consuming alcohol triggers flare-ups of HS.

Smoking:

Smoking can activate HS flare-ups through various mechanisms, adding another reason to avoid tobacco use.

Physical Injury:

Any form of friction or chronic trauma to the skin can act as a trigger for HS lesions.

Menstrual Cycle:

Women may notice a correlation between their menstrual cycle and HS flare-ups, with symptoms sometimes intensifying before menstruation.

Changes in Medication Usage:

Modifications in medication, particularly hormonal treatments, can lead to HS flare-ups. Patients experiencing changes in their medication should consult their certified dermatologist if they notice a worsening of their symptoms.

Stress and Emotional Distress:

Psychological stress can lead to flare-ups, making stress management essential for individuals with HS.

Being aware of these triggers can empower patients to take proactive steps in their lifestyle and management strategies, potentially reducing the frequency and severity of HS flare-ups.

Impact of Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) can significantly affect an individual's quality of life in various ways:

Social Withdrawal:

Many individuals with HS may avoid social interactions due to fear of embarrassment or stigma associated with their condition. The visible lesions and potential odor can contribute to feelings of self-consciousness.

Physical Discomfort:

Painful sores can interfere with daily activities, including sleep, mobility, and intimate relationships. This physical discomfort can lead to a decreased quality of life.

Emotional Distress:

The visible and painful symptoms of HS can lead to emotional challenges. Individuals may experience feelings of frustration, anger, and irritability as they cope with the physical and social limitations of their condition.

Mental Health Issues:

HS is often associated with mental health conditions such as depression and anxiety. The ongoing pain, social isolation, and frustration can contribute to these emotional challenges.

Quality of Life Concerns:

The combination of physical pain, emotional distress, and social isolation can create a sense of hopelessness or overwhelm. Many individuals find it challenging to maintain their usual activities and interests.

Importance of Support

Recognizing the impact of HS on mental and emotional well-being is crucial. Here are some ways to seek support:

Open Communication: Discuss your feelings and experiences with friends and family. Their understanding and support can be invaluable.

Professional Help: Consult with your family doctor or dermatologist for professional advice. They can provide resources and referrals for mental health support if needed.

Support Groups: Connecting with others who have HS can offer shared experiences and coping strategies, reducing feelings of isolation.

Prioritizing your mental and emotional health is vital for overall well-being. Seeking help and building a support network can make a significant difference in managing the challenges of HS.

Treatment

Hidradenitis suppurativa (HS) can typically be managed effectively with a combination of medical and surgical therapies. Given the chronic nature of the condition, it may take multiple treatments to achieve significant improvement.

Medical Therapies

Topical Treatments:

Antibiotics: These may be prescribed to reduce inflammation and prevent infections. Topical antibiotics can be applied directly to the affected areas.

Corticosteroids: These help decrease inflammation and can be used in the form of creams or injections.

Oral Medications:

Antibiotics: Oral antibiotics are often used for moderate to severe HS to control infection and reduce inflammation.

Hormonal Treatments: Hormonal therapies, such as anti-androgens (e.g., spironolactone), can be beneficial for some patients, particularly women whose symptoms correlate with their menstrual cycles.

Immunosuppressants: Medications like methotrexate or biologics (e.g., adalimumab) may be prescribed to modulate the immune system and reduce inflammation.

Pain Management: Pain relievers, including nonsteroidal anti-inflammatory drugs (NSAIDs), can help alleviate discomfort associated with HS lesions.

Surgical Therapies

Incision and Drainage: For acute flare-ups with abscess formation, incision and drainage may be necessary to relieve pain and promote healing.

Excision Surgery: In cases of recurrent or severe HS, surgical removal of the affected skin and tissue may be recommended to reduce the likelihood of flare-ups and prevent further complications.

Laser Therapy: Some patients may benefit from laser treatments, which can help reduce inflammation and promote healing in the affected areas.

Lifestyle Modifications

In addition to medical and surgical treatments, lifestyle changes can play a significant role in managing HS:

Weight Management: Achieving and maintaining a healthy weight may reduce friction and pressure in areas affected by HS.

Stress Reduction: Implementing stress management techniques can help minimize flare-ups.

Clothing Choices: Wearing loose-fitting, breathable fabrics can help prevent irritation in affected areas.

Regular follow-ups with a certified dermatologist are essential for tailoring the treatment plan to your specific needs and monitoring the condition's progression.

General Measures

In addition to medical treatments, implementing general measures can significantly help manage Hidradenitis Suppurativa (HS) and reduce the frequency and severity of flare-ups:

Wear Loose-Fitting Clothing:

Opt for loose-fitting garments made from moisture-wicking and absorbent fabrics. These materials can help keep the skin dry and minimize friction, reducing irritation in affected areas.

Avoid Manipulating Lesions:

Refrain from picking, squeezing, or rubbing the lesions. Doing so can exacerbate inflammation, cause lesions to enlarge, and increase the risk of infection.

Weight Management:

If you have a higher body mass index (BMI), consider adopting weight loss strategies. Reducing excess weight can help decrease skin-to-skin friction in areas affected by HS, which may alleviate symptoms and improve overall comfort.

Quit Smoking:

Smoking is linked to the worsening of HS symptoms. Quitting smoking can improve your overall health and may help reduce the severity of your condition. Resources and support for quitting smoking can be found at [www.quitsmoking.ca](http://www.quitsmoking.ca).

Dietary Adjustments:

Consider adopting a low glycemic index (GI) diet, which emphasizes low sugar and refined carbohydrate intake. This dietary approach may help manage inflammation.

Avoid skim milk products, as they have been associated with worsening HS symptoms for some individuals. Other dairy products can be consumed in moderation.

Be cautious with protein shakes that contain whey or casein protein, as these may trigger flare-ups for some patients. Explore alternative protein sources if necessary.

By integrating these general measures into your daily routine, you can enhance your management of Hidradenitis Suppurativa and improve your overall quality of life. Regular consultations with your healthcare provider will also ensure that your treatment plan remains effective.

Treatment Options for Hidradenitis Suppurativa

Managing Hidradenitis Suppurativa (HS) often requires a combination of medical, surgical, and laser treatments tailored to each individual’s needs. Here are the key treatment options available:

Medical Treatments

Topical Antibiotics:

Clindamycin: This topical antibiotic can be applied directly to the affected areas to help reduce bacterial growth and inflammation.

Topical Resorcinol (15% cream):

This compound needs to be filled at a compounding pharmacy and helps reduce the plugging of hair follicles. It's recommended for daily use for 12 weeks to help resolve current lesions, especially during flare-ups. Users should note that it may cause skin peeling.

Zinc Supplement:

An oral zinc supplement (100 mg once a day for 3-4 months) can help reduce inflammatory lesions. It's important to take a copper supplement (4 mg daily) at a different time, as zinc can inhibit copper absorption, potentially leading to anemia.

Hormonal Therapies:

These treatments can help reduce follicle plugging by blocking androgen hormones. For female patients, oral contraceptives containing drospirenone or cyproterone acetate may be prescribed for their anti-androgenic properties. However, they are not recommended for individuals with migraine auras, smokers over 35, or those with a history of blood clots.

Spironolactone is another anti-androgenic medication that can be effective, but it may lower blood pressure and is not recommended for those with severe kidney disease or pregnancy concerns.

Metformin:

Primarily used to improve insulin sensitivity in individuals with type 2 diabetes, metformin can also be beneficial in HS management by reducing androgen levels associated with high insulin.

Oral Antibiotics:

Although HS is not infectious, antibiotics like minocycline and doxycycline have anti-inflammatory effects and may be prescribed for three months to manage symptoms.

Biologics:

Adalimumab is the only FDA-approved biologic for HS, acting as an anti-inflammatory by blocking TNF-α production. Biologics are generally reserved for moderate to severe cases that have not responded to other treatments. Ongoing clinical trials may offer additional options, so consult your dermatologist about any research opportunities.

Surgical and Laser Treatments

Laser Hair Removal:

This procedure selectively targets hair follicles to prevent new lesions in hair-bearing areas, such as the underarms and pubic region.

Intralesional Corticosteroid Injections:

Corticosteroids can be injected directly into HS lesions to reduce inflammation and expedite healing. Inquire about the possibility of urgent fit-in appointments for these injections.

Botulinum Toxin Injections:

Though used off-label for HS, botulinum toxin has shown promise in reducing the number of lesions in treated areas by addressing excessive sweating (hyperhidrosis). Some insurance plans may cover this treatment.

Deroofing Surgery:

This in-office procedure, performed under local anesthetic, treats recurrent lesions and sinus tracts by removing the roof of the lesion. Deroofing can significantly improve quality of life by alleviating pain and drainage, and it often prevents recurrence in the same location. Discuss eligibility for this procedure with your dermatologist.

By exploring these medical and surgical treatment options, patients with Hidradenitis Suppurativa can find relief from symptoms, improve their quality of life, and manage their condition effectively. Regular consultations with a dermatologist can help determine the most suitable treatment plan.

Pain Management for Hidradenitis Suppurativa

Managing pain associated with Hidradenitis Suppurativa (HS) is an essential part of treatment, especially during flare-ups or chronic discomfort. Here are some effective strategies for alleviating pain:

Warm Compresses:

Gently applying a wet, warm compress to painful nodules can help reduce swelling and ease discomfort. The warmth can promote blood circulation and provide soothing relief.

Cold Therapy:

Ice packs can also be effective in managing mild pain and inflammation. Apply the ice pack wrapped in a cloth for 15-20 minutes at a time to avoid skin irritation.

Over-the-Counter Pain Relief:

Over-the-counter options such as ibuprofen or acetaminophen can help manage mild pain. Be sure to follow the recommended dosages and consult your doctor if you have any concerns or underlying health conditions.

Communication with Your Healthcare Team:

It's crucial to keep your healthcare provider informed about any pain you are experiencing. They can help tailor a treatment plan that addresses your pain management needs and provide guidance on wound care and symptom relief.

Remember, pain may vary in intensity and can be experienced during flare-ups or as a chronic issue. An open dialogue with your healthcare team is essential for effective pain management and overall well-being.

Wound Care for Hidradenitis Suppurativa

Effective wound care is crucial for managing Hidradenitis Suppurativa (HS), but there isn't a one-size-fits-all regimen. It's important to consult your dermatologist to develop a personalized wound care plan tailored to your specific needs. Factors such as the location of your wounds, the amount of leakage, the condition of the surrounding skin, cost, and your personal preferences will guide the choice of wound care products.

Cleaning

Use mild soap and water to gently cleanse the area around the wounds. Avoid harsh soaps that may cause irritation and exacerbate symptoms.

Drainage Management

If you experience excessive drainage, specialized dressings may be necessary. Absorbent dressings can be placed between the wound and your clothing to soak up any leakage, helping to keep the area dry and comfortable. In certain situations, advanced dressings may be recommended for optimal management.

Promoting Healing

To facilitate healing, it is essential to maintain a moist wound base; however, ensure it is neither too wet nor too dry. Regularly assess the condition of the dressings and change them as needed, especially if they become saturated or soiled. Wearing loose, breathable clothing can help reduce friction and irritation in the affected areas, further promoting healing.

By following these wound care principles and maintaining open communication with your healthcare provider, you can manage your HS more effectively and support your overall skin health.

Non-Infectious Nature: Hidradenitis Suppurativa (HS) is not an infectious or contagious disease, and it is not caused by poor hygiene.

Ongoing Research: There is a wealth of research focused on developing new treatments for HS. Your dermatologist is available to provide guidance and support in managing your condition.

Resources

Your dermatologist, nurse, pharmacist, and other members of your healthcare team are always great sources of information. Additionally, check out these websites for more information:

American Academy of Dermatology

[aad.org](https://www.aad.org)

Hidradenitis Suppurativa Foundation

[hsfoundation.org](https://hsfoundation.org)

Cleveland Clinic

[clevelandclinic.org](https://my.clevelandclinic.org/health/diseases/11453-hidradenitis-suppurativa)

HS eBook: An in-depth resource for HS patients that was written by dermatologists associated with the Hidradenitis Suppurativa Foundation can be found at [hsfoundation.org/ebook](https://hsfoundation.org/ebook).

Support Groups

Many people find it helpful to talk about how they’re feeling with others experiencing similar situations. Joining an in-person or online support group can be a great way to learn more about your HS community and pick up tips and tricks that others with the condition use in their daily lives.

U.S.-based HS patient organizations:

Hidradenitis and Me

[hidradenitisandme.com](https://hidradenitisandme.com)

HS Heroes

[hsheroes.com](https://hsheroes.com)

Contact a Dermatologist