What Is Hidradenitis Suppurativa?

Hidradenitis suppurativa, or HS for short, is a skin condition that is often confused with acne because they share many characteristics. In fact, you may hear HS referred to as Acne Inversa. It is, however, a much more serious condition, and although it can spread to the face, the original sites of affected skin are on the body around hair follicles.

Both HS and acne have a number of superficial blemishes, from blackheads (often found in pairs on HS sufferers) to tender, red bumps, to larger lumps (or nodules) that can split and drain fluid or pus. With HS, however, the lumps can grow to be the size of marbles, and they spread via pus-filled tunnels under the skin.

Acne does eventually go away after puberty, although it could take years. HS generally starts after puberty, and it might spread for a while, then stop, and even appear to go away. But the lumps can keep coming back again and again. And each time one breaks, your body is susceptible to infection. Scars are left over if these wounds heal, but sometimes they simply remain open sores.

Facts About Hidradenitis Suppurativa

Here are some facts you need to know about this chronic skin condition:

  1. Hidradenitis Suppurativa is said to be a hereditary disease. In other words, there is a possibility that you may develop this disease if it runs in your family. According to sources, genetic factors were to blame for one third of the people diagnosed with this condition.
  2. It is a chronic, but a non contagious, and a non fatal disease. The term chronic is used to describe this skin condition because there is no 100% effective cure for it. However, that doesn’t rule out the possibility of coming up with an effective cure in the future, keeping in mind how much medicine has advanced over the years!
  3. HS is an autoimmune disease. It’s a condition in which the body’s immune system mistakenly attacks and destroys healthy tissues.
  4. About 1 % of the population suffers from this dreadful skin disorder. However, the prevalence of this disorder is found to be three times more in women than men. It usually develops between the ages of 20 to 40.
  5. HS most commonly affects people who have acne and/or hirsutism, are smokers, or overweight. Losing weight and quitting smoking have helped alleviate symptoms in many people.
  6. HS is a lifelong disorder and can be quite difficult to cope with. However, this skin disease can be controlled to a good extend, if diagnosed and treated at early stages itself. But often due to embarrassment and ignorance, people hesitate to seek proper medical help. As a result, their condition gets worse and treatments turn out be less effective in the later stages.
  7. There may be a link between HS and hormonal imbalance. This disease rarely develops before puberty or after menopause. Flare-ups are often triggered at times of high hormonal activity. More than 50 % of people diagnosed with HS were reported to have had a history of acne.
  8. About 36 % of diagnosed HS patients (mostly men) were reported to have developed Pilonidal sinus or cyst (boil in the “tailbone” area /at the base of the spine).
  9. Contrary to popular belief, is not caused due to infection, poor hygiene or diet.
  10. Though at present there is no complete cures available, there are plenty of natural treatment options available that may help improve your condition. Medications like antibiotics, antiseptics, oral retinoid, colchicines and systematic corticosteroids may work for mild cases. But for those having severe and long term symptoms may need to undergo surgical procedures like laser ablation, cryotherapy, electron beam radiotherapy or CO2 laser treatment. However, the latter is considered to be the most effective option currently available.

Diagnosing Hidradenitis Suppurativa (Acne Inversa)

Is it The Same as Acne?

In short, no. Acne inversa is another name for hidradenitis suppurativa (HS), which is quite a different. Still, it’s easy to confuse the two. Following is a list of symptoms that the two conditions have in common:

  • Blemishes forming around hair follicles
  • Blackheads
  • Small red bumps
  • Scarring of affected skin

4 Unique Symptoms

Aside from these, however, there are other symptoms unique to each condition, not to mention different causes. Someone with acne could well have hidradenitis suppurativa, too, so if you think this describes you, look for the following additional symptoms:

1. Location of the condition

While acne often shows up on the face (as well as other parts of the body), HS may never get to the face, although it can spread there in a severe enough case.

While both conditions happen around hair follicles, HS starts in places with a lot of body hair or where skin touches skin, such as the armpits, groin, between the buttocks and inner thighs, around the genitals, under the breasts, and even behind the ears.

2. Foul-smelling leakage of nodules

With HS, your blemishes aren’t limited to embarrassing blackheads and whiteheads. They can enlarge to the size of a marble and leak fluid or pus, often foul-smelling. While there can be scarring when these heal, as with acne, they sometimes do not heal at all and remain open sores that could become infected.

3. Tunnels under the skin

The pus from the nodules can create tunnels, or unnatural sinuses, under the skin, spreading the condition around your body, making it painful and even more difficult to treat.

4. Lesions recurring in the same place

If at first you confuse the two similar yet different skin conditions, and the bumps go away, you may forget you had a skin problem – until the bumps show up again.

There can be periods of remission, but when the nodules return, they are usually worse than the last time. This tends to happen in cyclical patterns, so you may have stretches of no symptoms, followed by a very painful recurrence.

8 Questions to Expect During Diagnosis

Because of the periods of remission, you can be easily misdiagnosed or go undiagnosed for years.

Making it equally difficult, doctors cannot point to one specific cause; rather, there are a number of possible causes and risk factors. The answers to the following eight questions can help pinpoint whether you truly have HS or something else entirely.

  1. Are random boils, such as on your abdomen or thighs, a regular occurrence for you?
  2. Did your doctor-prescribed treatment to fix your problem?
  3. Do you have any other infections?
  4. Does fever accompany your lesions?

(A “no” to these could mean a diagnosis of acne inversa.)

  1. Are you related to anyone that already has this or with similar symptoms?
  2. Do the bumps happen in the same place every time they reappear?
  3. Do you smoke cigarettes?
  4. (For women) Before your monthly cycle, do you have a flare-up of nodules?

(A “yes” to these indicates that you could have acne inversa.)

You may be nervous about this diagnosis, especially if your answers lean towards having this disorder. Once diagnosed, however, your doctor will be better able to advise you about possible acne inversa treatments in order to minimize the symptoms and get you back to a state of comfort and good health again.

How Does Hidradenitis Suppurativa Start?

The first important step in tackling hidradenitis suppurativa is diagnosing it properly. Alternatively called acne inversa, many people can confuse the blackheads and pimple-like blemishes on their bodies with a severe case of acne.

This kind of misdiagnosis can significantly set you back in your treatment and allow the condition to spread, creating painful, infection-prone, pus-filled sinuses under the skin and putting you on a cycle of remission and flare-ups that could potentially last for decades.

Starting at hair follicles, similar to acne, hidrandenitis cannot be treated with prescription facial scrubs and by cutting sodas and chocolate out of your diet (although weight gain is an issue).

In fact, doctors cannot point to one cause, and people of all different ages, races, and both men and women can suffer from it. It does, however, most commonly develop in young adults after puberty, and females in particular.

If you think you have more than common acne, look for red bumps and nodules in the following places:

  • In the armpits
  • In the groin
  • Between the buttocks
  • Between the inner thighs
  • Under the breasts
  • Around the genitals

The disorder usually begins in these regions when the hair follicles located there become blocked. Bacteria trapped inside these follicles become inflamed, forming blackheads (often found in pairs), small red bumps, and larger lumps. From there, they could leak and become infected, forming tunnels under the skin, spreading infection and more nodules across a larger area.

Although doctors do not know why certain people’s bodies react this way while others don’t, certain risk factors could make you more likely to have it.

Reducing the Risk Factors

Overweight PersonAlthough you cannot avoid puberty or the changing hormones that come with it, nor can you change your genetics – such as if one of your parents also has it – there are other factors that you can control. See if any of the following risk factors describe you:

  • Are you a cigarette smoker?
  • Are you overweight?
  • Do you lead an inactive lifestyle?

Although doctors do not know the reason why these factors are all related, however the link is there, nevertheless. If the above three describe you, fortunately, they are all things you can control. Especially if you think you could have it, try to lessen the risk or improve your chances of treatment by eliminating these factors in your life.

Catching It Early

If you’ve never had any skin problems, and you notice a boil or tender bump in any of the areas specific to this condition – or even if you have them show up, and you’ve had acne for a while – pay attention. If the blemishes persist for weeks, even after you’ve tried your usual acne treatment, see a doctor.

7 Risk Factors And Triggers of HS

Doctors do not know of an exact cause, although they have been able to identify certain risk factors or attributes that many people with HS have in common. They include:

  • Age
  • Gender
  • Hormones
  • Smoking
  • Being Overweight
  • Stress
  • Genetics

Although people of any age or gender can obtain this skin condition, and it is commonly contracted by people after puberty into young adulthood, and women especially. For both of these demographics, hormones could have some connection, since the hormones of people who have recently gone through puberty, menstruating, or pregnant, are often changing.

There are also connections with cigarette smokers and those who are inactive or overweight, although the nature of those connections is not clear. As with so many conditions, stress could be either a trigger or an aggravator, and 30-40% of people who have HS are related to someone else who had it, too.

How Does HS Happen, and Can I Prevent It?

It usually originates around hair follicles, specifically under the armpits, in the groin, between the buttocks, between the inner thighs, and under the breasts. Oil and sweat glands are also found in these places, although it does not seem that oiliness of the skin has anything to do with this kind of outbreak.

For some reason, the hair follicles become inflamed, and the body’s reaction is to form one, two, or all of the types of blemishes listed above, and the cycle begins.

Since doctors do not yet know the exact cause, nor have they developed a cure for it, there is no sure way to prevent it. If you fit many or all of the risk factors listed above, however, you can lessen your chances by quitting smoking, creating a proper exercise and diet routine with you doctors, exploring hormone therapy (by either natural or pharmaceutical means), and reducing the stress in your life.

If you get HS anyway, and treating it at home with creams, medicinal baths, and natural hidradenitis suppurativa treatments is not improving your condition, seek medical attention to prevent further spread of lesions and perhaps receive more a effective treatment option.

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