What is Hidradenitis Suppurativa?
Hidradenitis Suppurativa (HS), otherwise known as acne inversa, is a chronic inflammatory skin condition that is likely caused by the immune system. It causes painful, reoccurring, and inflamed abscesses, lesions, or cysts to flare on the skin. These abscesses are often itchy and will drain fluid, pus, and blood. If they do not drain, the fluid will move inwardly underneath the skin, causing tunneling or sinus tracts. These sinus tracts are permanent and will not go away unless surgically removed. The abscesses and lesions will leave permanent purplish/red scars.
Is Hidradenitis Suppurativa contagious?
No. While we do not know a lot about what causes HS, we do know that HS is not contagious. It cannot be spread through the air, through bodily fluids, through bodily contact, on surfaces, from bacteria or a virus, or through sexual intercourse.
How do you get Hidradenitis Suppurativa?
Hidradenitis Suppurativa is a condition that affects the immune system and is probably caused by genes in your body. This means that you are born with HS; it cannot be caught from someone else.
Did I cause Hidradenitis Suppurativa?
No. Nothing you have done has caused your body to have this disease. It is not caused by poor hygiene or being dirty. It is not caused by eating certain foods (although some foods have been found to trigger inflammation in some people). It is not caused by shaving. HS is most likely a genetic condition that affects the immune system and possibly hormones.
How do you treat Hidradenitis Suppurativa?
There are multiple approaches to HS treatment. Your doctor, in partnership with you, will decide which is the best one for you. Here are some of the current treatment options:
- Topical and/or oral antibiotics – Many antibiotics have anti-inflammatory components to them, which is why they are prescribed to treat HS. They also can combat any risk of infection that someone with HS faces due to open wounds. Some of the antibiotics I have been prescribed are: dapsone, clindamycin, rifampin, doxycycline and minocycline.
- Biologics – Without getting too bogged down in the details, biologics are drugs that are made from living organisms. HS is currently thought to be triggered by proinflammatory proteins in your body. The intent of biologics is to combat those proteins and lower inflammation. Adalimumab, or Humira, is currently the only FDA approved medication for HS. Some other biologics are: Remicade (infliximab), Cosentyx (secukinumab), and Xeljanz (Tofacitinib)
- Hormonal treatments – such as birth control pills, spironolactone, metformin, or finasteride.
- Steroids – both intralesional and oral. Intralesional steroids are injected into your HS lesion at your doctors office to reduce inflammation and shrink the abscess. Oral steroids are given for a short period of time to systemically reduce inflammation.
- De-roofing – This procedure can be done by your dermatologist or surgeon. Your doctor will remove the skin covering an abscess or sinus tract and leave the wound open to heal. This procedure is usually done for specific HS locations that are reoccurring and are smaller than the wide excision option.
- Surgery – Wide excision surgery is often for severe HS that has spread over a wide area of skin. Skin is cut out during surgery to remove all of the damaged skin, including tunnels. This approach will need to done in close collaboration with a surgeon and possibly a plastic surgeon. The risk with surgery is that HS may return once the skin is healed.
This list is not comprehensive nor exhaustive. When treating HS, you should do so in close consultation with your doctor.
I think I have Hidradenitis Suppurativa. What should I do?
Talk to your doctor. Your primary care physician or dermatologist can diagnose you with HS and start treatment.
Here are some tips to help you with that conversation: bring images from the internet of HS and/or information sheets from a site like The Mayo Clinic or American Academy of Dermatology. Write down your symptoms and bring it to your appointment. Bring images of your skin from when you had a flare. Find out if you have a family history of HS or something similar. Check out one of the HS clinics where they have dermatologists that specialist in HS. The HS Foundation has a great list of HS clinics.
I encourage you to educate yourself on HS as well. Go to the resources page in the menu to find a list of resources and research on Hidradenitis Suppurativa. You also may want to join an HS support group to learn about what others do for HS and find a support network. There are some on Facebook as well as Instagram.