Hydradenitis Suppurativa (HS) is a chronic, or ongoing, inflammatory skin condition that is similar to acne but can be much more severe. HS affects inverse areas of the body, places where skin rubs together, such as the tops of the inner thighs, between the buttocks, the genitals, and the armpits. In women HS can also occur under the breasts.
HS is the result of the apocrine sweat glands being clogged, resulting in lesions that may be as small as blackheads or pimples, or may be large draining lesions the size of golf balls. HS tends to begin after puberty, persist for years and get worse over time, so early diagnosis and treatment is important for managing symptoms and preventing new lesions from developing.
HS is painful and can be disabling, but is rarely fatal unless it progresses to overwhelming system infection in a patient with a compromised or weakened immune system. The condition affects only one to two percent of the population, but is more common in women than in men.
There are several theories about the cause of HS, but it’s important to know that HS is not caused by dirt. Here are some of the suspected causes of the condition:
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Genetic predisposition – some studies show that more than a third of patients with HS have a relative who also has the disease.
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Excessive perspiration – excessive perspiration is common in athletes and the obese, and may contribute to the clogging of the apocrine glands.
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Stress and smoking – occurrence of the condition tends to worsen in periods of stress, while quitting smoking has been shown to reduce the severity of the outbreaks.
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In relation to other conditions – sometimes HS is a primary condition, meaning it is present without any sign of another disease or condition, but it may also be observed in association with the following conditions:
- Crohn’s disease
- Irritable bowel syndrome
- Down syndrome
- Certain forms of arthritis
- Graves disease
- Hashimoto thyroiditis
- Sjogren syndrome
- Herpes simplex
There are three clinical stages of HS:
Stage 1 – single or multiple abscesses form without sinus tracts or scarring
Stage 2 – recurrent abscesses form, causing tract formation under the skin and scarring
Stage 3 – widespread lesions and multiple, interconnected lesions are formed with tracts and abscesses across the entire affected area
Symptoms of Hydradenitis Suppurativa
Signs and symptoms of HS include:
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Blackheads – these are small, pitted areas of skin containing blackheads. They often appear in pairs or a “double barreled” pattern.
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Tender red bumps – these bumps, also called lesions, can enlarge, break open and drain pus that may have an unpleasant odor. Itching, burning and excessive sweating may occur with the bumps.
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Painful pea-sized lumps – these lumps occur under the skin and are hard to the touch. They may persist for years, enlarge and become inflamed.
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Leaking bumps or sores – open wounds that heal very slowly or not at all, and often lead to scarring and the development of tunnels under the skin.
Diagnosing Hydradenitis Suppurativa
If your child has had more than three boils in one year you should visit a doctor for a diagnosis, as these can be a sign of many different illnesses. A diagnosis of HS is typically made by observing where the lesions are and the presence of blackheads and scarring.
Treatment for Hydradenitis Suppurativa
There is no single treatment for HS that works for all patients, so you may need to try several different approaches to treatment before finding what works best for your child. Shriners Hospitals for Children® offers these treatments for HS:
- Antibiotics for prevention of the formation of new lesions and to protect against infection.
- High-dose systemic steroids to reduce inflammation.
- Birth control pills to regulate hormone production.
Surgical treatments may be needed depending on the severity of your child’s case. Surgical treatments may include:
- Incision of the lesion for drainage
- Removal of recurring lesions and connecting tracts
- Skin grafts or other plastic surgery to repair poorly healed sites