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Hidradenitis Suppurativa -ˌsəp-yu̇-rə-ˈtī-və

By Jonette E. Keri, MD, PhD, Associate Professor of Dermatology and Cutaneous Surgery;Chief, Dermatology Service, University of Miami, Miller School of Medicine;Miami VA Hospital

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Hidradenitis suppurativa is inflammation of the hair follicles in the skin under the arms, in the groin, and around the nipples and anus, resulting in scarring, inflammation, and painful accumulations of pus under the skin.

  • The cause of hidradenitis suppurativa is not known.

  • Bumps that look like acne form on the skin, followed by painful abscesses and sinus tracts.

  • To diagnose hidradenitis suppurativa, doctors examine the skin.

  • Treatment depends on severity but may include creams applied to the skin, antibiotics and other drugs taken by mouth, and surgical procedures.

Hidradenitis suppurativa develops in some people after puberty when the hair follicles (the pores in the skin where hair grows) under the arms, in the groin, and around the nipples and anus are chronically blocked and become inflamed. The hair follicles may swell and form bumps that look like acne. Doctors do not know why the blockage occurs, but it is not related to poor hygiene, to the use of deodorants or powders, or to underarm shaving.

The blockage causes the hair follicles to swell and rupture, sometimes leading to infection by various bacteria. The abscesses (pus-filled pockets) that result are tender, painful, and foul smelling, can grow deep into the skin, and tend to reappear if they heal. After the abscesses heal and reappear repeatedly, the skin in the area becomes thick and scarred. Often, permanent channels (called sinus tracts) form between the abscess and the skin surface and drain pus.

Hidradenitis suppurativa may cause only a few abscesses and be mild or may cause many abscesses and sinus tracts and be severe. Hidradenitis suppurativa can affect a person's quality of life because it causes pain and because the foul odor may cause embarrassment.

Diagnosis

  • Examination of the skin

  • Culture of abscesses

Hidradenitis suppurativa abscesses resemble other skin abscesses. Doctors base the diagnosis on an examination of the skin, noting the location of the bumps and abscesses and determining whether they heal and reappear often.

Doctors sometimes take samples of pus from deep abscesses and have the bacteria identified by a laboratory (culture).

Treatment

  • Depends on severity

For people with a mild case of hidradenitis suppurativa, a doctor injects corticosteroids into the area and prescribes antibiotics, such as tetracycline or erythromycin or clindamycin, to be taken by mouth (orally). Clindamycin and resorcinol creams applied to the skin (topically) are also given, and people should wash the area with benzoyl peroxide. All of these drugs may be used together or alone.

For people with a moderate case of hidradenitis suppurativa, a doctor gives the same oral antibiotics as for mild cases, and sometimes rifampin (another oral antibiotic), but for a longer period (2 to 3 months). The doctor may cut open the abscesses to drain the pus. Doctors may give women drugs that block the effects of male sex hormones, such as oral contraceptives, spironolactone, or finasteride. Sinus tracts are opened and drained.

For people with a severe case of hidradenitis suppurativa, a doctor gives infliximab (by vein) or adalimumab (by skin injection) to reduce inflammation. Isotretinoin or acitretin (by mouth) may reduce inflammation. If the disorder continues, a doctor cuts out the involved area and then repairs the skin or does a skin graft. Laser treatment to remove the damaged skin or hair may also be done.

Although it will not cure the condition, all people with hidradenitis suppurativa should maintain good skin hygiene and treat the skin gently. Psychologic support and avoiding a high-glycemic index diet may help as may losing weight.

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