Hidradenitis Suppurativa – Diagnosis and Treatment
Diagnosis
Doctors usually diagnose hidradenitis suppurativa (HS) by examining your skin and asking about your medical history. HS often looks like regular pimples or boils, especially where skin rubs together—think armpits or groin.
They look for painful lumps, abscesses with pus, or tunnels under the skin (sinus tracts).
Key points doctors check for HS diagnosis:
- Recurring boil-like lumps
- Areas with sweat or friction (armpits, groin)
- Signs of inflammation and chronic skin disease
- Family history of HS or related conditions
No blood test can confirm HS, but if infection seems likely, your provider might test pus from a sore. If things aren’t clear, a dermatologist will help rule out other skin issues or complications, including squamous cell carcinoma or anemia.
Treatment
Medicine-Based Approaches
Plenty of different medications can help manage hidradenitis suppurativa. The best option depends on how severe your symptoms are and how you respond to treatment.
| Medicine Type | Used For | Notes |
|---|---|---|
| Topical Antibiotics | Mild cases | Applied to skin |
| Oral Antibiotics | Moderate/Severe | May combine agents |
| Steroids | Swelling/Inflamm. | Injected into lesions |
| Hormonal | Hormone-related | Especially in women |
| Retinoids | Severe/Acne-like | Not for pregnant patients |
| Biologics | Moderate/Severe | Given by injection |
| Pain Relievers | All levels | Stronger meds if needed |
| Topical Cream | Reduce blockages | Calms skin, aids healing |
Topical and Oral Antibiotics
For mild HS, doctors sometimes recommend topical antibiotics like clindamycin gel or lotion to fight infection and reduce swelling.
If the condition is more widespread, oral antibiotics may be necessary. Common choices include tetracycline-class, macrolide, and lincosamide antibiotics. In some cases, a rifamycin-class antibiotic may be added if symptoms persist.
Combination therapy can help with stubborn or severe cases. People sometimes stay on antibiotics for months if flare-ups keep happening.
Steroid Treatments
Doctors might inject corticosteroids like triamcinolone to control swelling and speed up healing. Steroid creams or pills aren’t used as often, but they’re sometimes suggested.
Hormone Help
Hormonal treatments—such as oral contraceptives or anti-androgens—may help reduce outbreaks, especially in women. Some people may be prescribed a 5-alpha reductase inhibitor if other hormone therapies are ineffective.
Oral retinoids, such as those used for severe acne or keratinization disorders, can also improve acne-like symptoms. However, they are strictly contraindicated during pregnancy or breastfeeding due to the risk of birth defects.
Medicines That Target the Immune System
Biologics can lower your immune response and reduce inflammation. These medicines are usually injections and are considered for moderate or severe HS.
Other Treatments
Doctors sometimes use resorcinol cream to break down blockages in hair follicles and calm irritated skin. Over-the-counter painkillers like acetaminophen or ibuprofen can help, but stronger pain meds might be needed sometimes.
Surgical Care and Extra Steps
Sometimes, medication just isn’t enough. Surgery or certain procedures can help if you have bumps, tunnels under the skin, or abscesses.
| Procedure | Description | Used For |
|---|---|---|
| Unroofing | Opens tunnels under skin to let them heal | Moderate/Severe cases |
| Punch Debridement | Removes one painful lump | Targeted, single lesions |
| CO2 Laser Therapy | Burns and removes lesions and tunnels | Early treat or moderate cases |
| Wide Excision | Removes all affected tissue, may need skin graft | Severe, repeat symptoms |
| Incision/Drainage | Cuts and drains sore for quick comfort | Short-term pain only |
Revealing Under-the-Skin Tunnels (Unroofing)
Doctors remove the tissue covering tunnels so they can heal. This is usually for moderate or severe HS.
Punch Removal (Limited Unroofing)
If you’ve got one painful lump, a small piece of skin gets removed to clear out the blockage.
Laser Treatments
Carbon dioxide lasers can destroy and heal sores, which might help prevent them from coming back. Laser hair removal sometimes slows down early disease, too.
Full Excision Surgery
For stubborn or widespread symptoms, doctors might cut out all affected skin. Sometimes, they use a skin graft to close the wound. Even then, HS can come back elsewhere.
Cutting and Draining Sores
Incision and drainage can give quick pain relief, but sores usually return. Doctors don’t rely on this as a main treatment for HS anymore.
Tips for Daily Living and At-Home Care
Taking care of your skin and making healthy choices can help you manage mild HS at home. Self-care works alongside medical treatment and might reduce discomfort or flare-ups.
Practice Gentle Skin Hygiene
Wash daily with a gentle, non-soap cleanser to protect sensitive skin. Some people use antiseptic washes like chlorhexidine 4% or benzoyl peroxide, starting once a week. You can increase use if your skin tolerates it.
Always pat your skin dry after washing. Skip rough sponges or washcloths—they irritate affected areas. Don’t squeeze sores or pimples. Shaving or using depilatory creams can make things worse, so it’s best to avoid those.
Manage Pain and Swelling
Apply warm compresses gently to irritated spots to help with pain and swelling. Over-the-counter pain relievers can help, but talk to your provider for wound care and pain management advice.
Reach and Maintain a Healthy Weight
Carrying extra weight can make symptoms worse. Aim for a healthy weight and stay active, choosing exercises that don’t put extra pressure on skin folds or sensitive spots.
Make Smart Clothing Choices
Wear loose-fitting clothes to let your skin breathe and avoid chafing. Tight or rough clothing can make symptoms worse, especially in hot or humid weather.
Adjust Diet When Needed
For some, foods high in dairy, red meat, or sugar make symptoms worse. A dietitian can help you plan meals that fit your needs.
Stop Smoking
Quitting smoking may reduce symptoms and flare-ups.
Minimize Heat and Humidity Exposure
Hot, humid weather often makes symptoms worse. Try to stay cool and use fans or light clothes to cut down on sweating.
Healthy Ways to Manage and Find Support
Living with hidradenitis suppurativa can affect more than just your skin. The pain and discomfort might lead to stress, social withdrawal, or depression. Honestly, emotional well-being is just as important as physical care.
Here are some ways to support your mental health and daily life:
- Connect with Others: Share experiences with family, friends, or people who understand what you’re going through.
- Seek Professional Help: Counseling or therapy can help manage anxiety or low mood.
- Join a Support Group: Swapping advice and stories can make things easier.
- Manage Stress: Try relaxation exercises or gentle movement like swimming or Pilates.
A table for support options:
| Support Option | Benefit |
|---|---|
| Professional counseling | Helps handle depression, stress |
| Support groups | Reduces isolation |
| Family and friends | Provide understanding |
Getting Ready for Your Visit
Steps to Take Before Seeing Your Healthcare Team
Before your appointment, gather important details. List all your symptoms, even the ones that seem minor or unrelated.
Write down every medication, supplement, and vitamin you take, along with the doses. This helps your provider see the whole picture.
Think about questions you want to ask. Here are a few ideas:
- What might be causing my symptoms?
- Are there other possible explanations?
- Will I need any tests?
- How long could this last?
- What are my treatment options?
- What side effects should I expect?
- Could this be linked to another health issue?
Tip: Use a table or notebook to organize your questions and medications. It’ll help your appointment go more smoothly.
| Information to Note | Details |
|---|---|
| Symptoms | Write down all symptoms |
| Medicines/Supplements | List names and doses |
| Questions | Have a list ready for your provider |
Questions You Might Be Asked
Your healthcare provider will probably ask several questions to understand your situation better. Some might include:
- When did your symptoms start?
- What did the skin areas look like at first?
- Do the same spots keep coming back?
- Is there pain with your symptoms?
- Has anyone in your family had similar issues?
- What makes the symptoms better or worse?
- Do you smoke or use tobacco?
Being ready for these questions can make your appointment smoother and help your provider pick the best care plan.
