Hidradenitis suppurativa

What is hidradenitis suppurativa?

Hidradenitis suppurativa is a long-term, inflammatory skin condition, which can come back despite treatment. It causes painful boils or abscesses beneath the skin, usually in areas where your skin rubs together or in areas where you have a high density of sweat glands. 

It can also cause tunnels beneath the skin that can become infected and leak pus. 

Common areas include: 

• Underarms

• Groin

• Breasts

• Bottom 

How common is hidradenitis suppurativa? 

This skin condition happens in around 1-4% of people and is more common in women.

What are the symptoms of hidradenitis suppurativa?

Hidradenitis suppurativa symptoms can range from mild to severe. Here are some of the key symptoms and stages:

• Initially, you might notice a small lump or boil. This is usually painful and can remain for weeks. 

• More lumps or boils might follow after the initial lump has developed. These might form in clusters. 

• Some lumps can get bigger and split open, which can lead to the lump leaking pus. 

• If your hidradenitis suppurativa develops further, it can lead to the formation of tunnels under the skin, which link two areas. 

• Deep scars can form as the lumps or tunnels heal. 

What causes hidradenitis suppurativa?

Unfortunately, the cause of hidradenitis suppurativa isn’t yet known. Doctors think that the lumps can form because of a blockage to the sweat glands. As the blockage prevents any more sweat that is produced from leaving, bacteria multiply and cause inflammation and, on occasion, infection. 

The condition may also be linked to your hormones, as it only occurs after puberty and symptoms can be worse before the start of your period, however, more research needs to be done here. 

There are some factors that can increase your chance of developing hidradenitis suppurativa, including: 

• Being a smoker

• Having an insulin-resistant condition like diabetes

• Having acne

• Having an inflammatory bowel disease (IBD) like Crohn’s disease or ulcerative colitis

What are the key stages of hidradenitis suppurativa? 

There are three key stages:

• Stage 1 – a painful or pus-filled lump without any scarring

• Stage 2 – recurrent infected lumps with some tunnelling beneath the skin or scarring. These can be single lesions or multiple separated lesions

• Stage 3 - widespread lesions with tunnelling, scarring, and abscesses.

How is hidradenitis suppurativa diagnosed?

There isn’t a definitive test for hidradenitis suppurativa. Often, a doctor will examine any lesions or lumps, and they might take a swab of the affected area. 

Your doctor will look for 3 of the key signs: 

• Characteristic lesions 

• Typical placement: this is usually in the armpits, the groin and the breast

• Presence or recurrence of lesions

You may be offered a blood test to check that there are no underlying conditions, such as diabetes. 

How is hidradenitis suppurativa treated?

Initially, a doctor will look to see how far your hidradenitis suppurativa has progressed. Depending on your symptoms, they will usually prescribe pain relief and antibiotics.

It can help to wear loose fitting clothing and to try not to get too hot and sweaty. Keep the area dry. 

If after initial treatment, your hidradenitis suppurativa doesn’t improve, you may be referred to a dermatologist. They can offer more specialised treatments like retinoids. In rare cases you may need surgery to remove affected areas.

The skin condition can be distressing and make you feel low. If this is the case, talk to a doctor and they may be able to refer you to talking therapy.

Although it might seem quite difficult to treat, try to seek help as early as possible as treatment is more effective the earlier the stage of hidradenitis suppurativa.

When should I speak to a doctor?

If you find a new lump, abscess or lesion, it’s best to speak to a doctor or healthcare professional. If you’ve already sought treatment but your hidradenitis suppurativa isn’t getting better, you’re still in severe pain or it’s affecting your day-to-day, it’s a good idea to book an appointment to discuss your options.

How can Livi help?

A Livi doctor will ask you questions about your symptoms. They’ll make an individual assessment, recommend a treatment or refer you to a specialist if needed.