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Hidradenitis suppurativa: Overview

Living with hidradenitis suppurativa

What hidradenitis suppurativa can feel like: A deep, painful lump can develop in your armpit for many reasons, including a little-known condition called hidradenitis suppurativa.

What is hidradenitis suppurativa?

Hidradenitis suppurativa (HS) is a little-known disease that causes deep and painful lumps under the skin, usually in the armpits or groin.

Many people mistake the deep lumps for painful pimples or acne cysts. HS can also be misdiagnosed as boils, infected hair follicles (folliculitis), or a sexually transmitted disease.

Because HS is often mistaken for another condition, people can go years without getting the care they need. Some people live with HS for 12 years or longer before getting diagnosed.1

Without the right diagnosis and individualized treatment, HS can worsen. What starts out as one or two deep, painful, pimple-like lumps can turn into several lumps. In time, these lumps can break open and leak a foul-smelling liquid. The lumps can continue to return, rupture, and heal.

Hidradenitis suppurativa is:

● NOT a sexually transmitted disease
● NOT caused by unclean skin
● NOT contagious

Upset African American girl sitting on couch with cellphone, thinking about something.

As the disease progresses, it can cause tunnels beneath your skin and permanent scars. The skin with HS can be so painful that people can have trouble sitting or walking when HS forms in the groin area. If HS develops in the armpits, it can cause difficulty reaching. The scars can permanently limit how far you can stretch or bend.

People who go undiagnosed for years can develop intense pain and slow (or non-healing) wounds. To get relief from the pain and wound care, they often go to the emergency room (ER). According to a study conducted in Canada, some people return to the ER 10 or more times before getting diagnosed with HS.2

Dermatologists trained to recognize hidradenitis suppurativa

Do you have acne-like breakouts in your armpits, groin area, or elsewhere that won’t heal (or heal and return)? If so, it’s time to see a dermatologist.

To a dermatologist’s trained eye, there are differences between HS and other conditions. Dermatologists receive the training needed to spot these differences.

With an accurate diagnosis and proper treatment for HS, you can:

  • Prevent HS from worsening

  • Relieve pain

  • Heal slow (or non-healing) wounds

  • Treat infection

Research has led to many treatment advances in recent years

Breakthroughs in HS research have led to a better understanding of this disease. Researchers have learned that in the United States, HS is most common in African American women.

The research advances have also led to better treatment for HS.

Many patients now receive a treatment plan customized to their needs. A treatment plan may include:

  • Skin care

  • Medication

  • A procedure that can be performed in your dermatologist’s office, such as draining a painful lump

  • Lifestyle changes

It’s important to know that HS cannot be cured. However, when you receive treatment tailored to your needs, HS does not have to stop you from living the life you want to live.

When you see a dermatologist for HS, your dermatologist will watch your health closely. People with HS have a higher risk for developing some health conditions, including arthritis, diabetes, and heart disease.

For this reason, dermatologists often work closely with other doctors. Doing so helps you get the care you need.

Your dermatologist can also watch for signs of skin cancer on your skin. Some people with HS have a higher risk of developing a common type of skin cancer called squamous cell carcinoma (SCC). In people who have HS, this skin cancer tends to develop in unexpected places. It most frequently develops around the anus or elsewhere in the groin area.

Dermatologists are skin cancer specialists, so they can spot signs of skin cancer early. Caught early, SCC is highly treatable.

What hidradenitis suppurativa looks like

If you think that you may have HS, you’ll find pictures of what it can look like and learn about symptoms at, Hidradenitis suppurativa: Signs and symptoms.

Image 1: Video by AAD
Image 2: Getty Images

Alikhan A, Sayed C, et al. “North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations Part I: Diagnosis, evaluation, and the use of complementary and procedural management.” J Am Acad Dermatol 2019;81:76-90.

Alikhan A, Sayed C, et al. “North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations Part II: Topical, intralesional, and systemic medical management.” J Am Acad Dermatol 2019;81:91-101.

Bowers J. “Tailor-made care.” Dermatol World. 2020;30(7);114-9.

Garg A, Neuren E, et al. “Evaluating patients’ unmet needs in hidradenitis suppurativa: Results from the Global Survey Of Impact and Healthcare Needs (VOICE) Project.” J Am Acad Dermatol 2020;82:366-76.

Lee EY, Alhusayen R, et al. “What is hidradenitis suppurativa?” Can Fam Physician. 2017;Feb;63(2):114-120.

Lyons AB, Shabeeb N, et al. “Emerging medical treatments for hidradenitis suppurativa.” J Am Acad Dermatol 2020;83:554-62.

Narla S, Price KN, et al. “Proceeding report of the fourth Symposium on Hidradenitis Suppurativa Advances (SHSA) 2019.” J Am Acad Dermatol. 2020;S0190-9622(20)30989-0. doi: 10.1016/j.jaad.2020.05.114. Online ahead of print.

Saunte DML, Jemec GBE, et al. “Hidradenitis suppurativa: Advances in diagnosis and Treatment.” JAMA. 2017;318(20):2019-32.