Hidradenitis Suppurativa*

Find comfort in knowing that others feel your pain and know what you go through while having to live with this devastating condition.

Hidradenitis suppurativa (hi-drad-uh-NI-tis sup-u-ra-TI-va) is a chronic skin inflammation marked by the presence of blackheads and one or more red, tender bumps (lesions). The lesions often enlarge, break open and drain pus. Scarring may result after several recurrences.

Considered a severe form of acne (acne inversa), hidradenitis suppurativa occurs deep in the skin around oil (sebaceous) glands and hair follicles. The parts of the body affected — the groin and armpits, for example — are also the main locations of apocrine sweat glands.

Hidradenitis suppurativa tends to start after puberty, persist for years and worsen over time. Early diagnosis and treatment of hidradenitis suppurativa can help manage the symptoms and prevent new lesions from developing.

Hidradenitis suppurativa commonly occurs around hair follicles where many oil and sweat glands are found, such as the armpits, groin and anal area. It may also occur in areas where skin rubs together, such as the inner thighs, under the breasts or between the buttocks. Hidradenitis suppurativa can affect a single area or multiple areas of the body.

Signs and symptoms of hidradenitis suppurativa include:

* Small pitted areas of skin containing blackheads, often appearing in pairs or a "double-barrel" pattern.
* One or more red, tender bumps (lesions) that fill with pus. The bumps often enlarge, break open and drain pus. The drainage may have an unpleasant odor. Itching, burning and excessive sweating may accompany the bumps.
* Painful, pea-sized lumps that grow under the skin. These hard lumps, which may persist for years, can enlarge and become inflamed.
* Painful bumps or sores that continually leak fluid. These open wounds heal very slowly, if at all, often leading to scarring and the development of tunnels under the skin.

Hidradenitis suppurative often starts at puberty with a single, painful bump that persists for weeks or months. For some people, the disease progressively worsens and affects multiple areas of their body. Other people experience only mild symptoms. Excess weight, stress, hormonal changes, heat or excessive perspiration can worsen symptoms.

When to see a doctor
Mild cases of hidradenitis suppurativa may be treated with self-care measures. But if the condition doesn't improve in one to two weeks, appears in several locations, recurs often or is painful, consult your doctor or a dermatologist. Most often, medical treatments — such as prescription medications or surgery — are necessary to manage the problem.

Hidradenitis suppurativa occurs deep in the skin around oil (sebaceous) glands, apocrine sweat glands and hair follicles. The apocrine sweat glands release fluid, dead skin cells and other substances into the hair follicle. This mixes with the oil from the sebaceous gland. Hidradenitis suppurativa develops when the oil glands and hair follicle openings become blocked with these substances. When oils and other skin products become trapped, they push into surrounding tissue. Bacteria can then trigger infection and inflammation.

It's not known why this blockage occurs, but a number of factors — including hormones, genetics, cigarette smoking and excess weight — may all play a role.

Sometimes hidradenitis suppurativa occurs with other diseases, such as Crohn's disease, herpes simplex or Grave's disease.