Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition causing cysts, abscesses, sinus tracts and scarring. It primarily presents underneath the arms, in the groin or buttock areas or underneath the breasts, however it can occur elsewhere. HS is much twice as common in females than males and typically presents between puberty and 40 years old. There are several factors which contribute to the development and worsening of HS including genetic susceptibility, obesity, smoking, diet and hormonal factors. 

HS is more common in overweight or obese persons; however, it is not limited to them. The majority of HS patients are smokers and smokers are typically found to have more severe disease than non-smokers. Hormones are thought to play a role in HS because it is typically only seen post-puberty.

The first presentation of HS is typically an inflamed bump (nodule) underneath the skin in the armpits, groin, buttocks or under the breasts. This nodule often progresses to form an abscess which may or may not drain. With the development of many nodules over time is when sinus tracts begin to appear which are tunneling wounds underneath the skin. Subsequently, severe scarring can develop. HS can cause significant pain and recurrent drainage/odor at the affected sites. Embarrassment, depression and even an increased suicide risk have been noted in HS patients. It can significantly impact quality of life.

Stage 1 is defined as single or multiple abscess formation without sinus tracts or scarring. Stage II is defined as recurrent abscesses with sinus tracts and scarring, single or multiple widely separated lesions. Stage III is defined as diffuse involvement or multiple interconnected sinus tracts and abscesses.

Treatment includes lifestyle modifications, over the counter products and prescription medications. Weight loss and smoking cessation can help decrease the severity of HS. It is also recommended to wear loose, light clothing to avoid friction and trauma to the areas. Over the counter antiseptic washes are advised starting once a week to the affected areas and increasing to once daily as tolerated by the skin. There are several other prescriptions therapies which can improve HS, your dermatologist – Dr. Saini – will evaluate your condition and determine the best options for therapy.