Diagnosis

Your doctor will ask you about your signs and symptoms, examine your skin and take your medical history.

No laboratory test is available to diagnose hidradenitis suppurativa. But if pus or drainage is present, your doctor might send a sample of the fluid to a laboratory for testing. This can help rule out other conditions, such as an infection.

Treatment

Treatment with medications, surgery or both may help control symptoms and prevent complications. No single option has been proven to be completely reliable, and research continues to determine the best combination. Talk with your doctor about the risks and benefits of the various treatment options and developing an approach tailored to your situation.

Expect to have regular follow-up visits with your dermatologist or a multidisciplinary health care team that can provide the comprehensive care often required by people with hidradenitis suppurativa.

Medications

Your doctor might prescribe one or more of the following types of medications:

  • Antibiotic creams. Mild symptoms might be managed with topical creams that fight infections, such as clindamycin and gentamicin.
  • Systemic drugs. For more widespread diseases, antibiotics taken by mouth, such as clindamycin, rifampin and doxycycline, may help. An injection of adalimumab may be used for moderate to severe disease, though it may take about two weeks to notice any benefit. And small studies have shown the injectables infliximab and anakinra to be effective.
  • Pain medication. If over-the-counter pain relievers don't help, your doctor may prescribe a stronger type.

Surgery

Surgical options include:

  • Uncovering the tunnels. Known as unroofing, this procedure involves removing tissue to expose the tunnels under the skin. It is used for people with moderate and severe hidradenitis suppurativa. This solution usually doesn't have to be repeated.
  • Punch debridement. This procedure is also called limited unroofing and may be used to remove a single inflamed nodule.
  • Tissue-sparing excision with electrosurgery. This may be an option for people with severe hidradenitis suppurativa. It combines skin-tissue-sparing removal (excision) of damaged tissue with electrosurgical peeling.
  • Laser therapy. Carbon dioxide laser can be used to make lesions go away.
  • Surgical removal. Surgical treatment may be an option for people with persistent or severe symptoms. It involves removing all of the affected skin. A skin graft may be necessary to close the wound. Even after you have surgery, sores may still occur in other areas. In men whose condition involves the area between the anus and scrotum, surgical removal of the scrotum is almost always necessary.
  • Incision and drainage. Surgical drainage is no longer considered an effective option for treating hidradenitis suppurativa. The method may be considered to provide short-term pain relief, but sores tend to flare again.

Emerging therapies

More studies of surgical options are needed to improve hidradenitis suppurativa care. In particular, good-quality clinical trials are needed to evaluate the timing or surgery and type of surgical procedure. Other interventions being studied are topical antiseptics, novel biological therapies and further study of adalimumab.

Lifestyle and home remedies

Mild hidradenitis suppurativa may be treated with only self-care measures. But self-care is also an important complement to any medical treatment you may be getting. The following suggestions may help relieve discomfort, speed healing or prevent outbreaks:

  • Follow a daily skin care routine. Gently wash your body with a nonsoap cleanser such as Cetaphil. It may help to use an antiseptic wash such as chlorhexidine 4% when showing. First try it once a week, then increase usage up to once a day if your skin tolerates it well.

    When washing, avoid using washcloths, loofahs or other items on affected areas, as they can irritate skin. Then apply an over-the-counter antibiotic cream or a cream containing the antimicrobial benzalkonium chloride. It might also help to apply extra absorbent powder or zinc oxide.

  • Manage your pain. Gently applying a wet, warm washcloth, tea bag or other sort of compress can help reduce swelling and ease pain. Keep it on for about 10 minutes.

    Ask your doctor to recommend the most appropriate pain reliever. And talk with your doctor about how to properly dress and care for your wounds at home.

  • Avoid tight clothes and irritating products. Wear loose, lightweight clothes to reduce friction. Some women find that using tampons rather than sanitary pads causes less friction with the skin. Use detergents and other products that are free of perfumes, dyes and enzymes.
  • Avoid injuring the skin. For example, don't squeeze the pimples and sores. And stop shaving affected skin.
  • Keep a healthy weight and stay active. Not being at a healthy weight can worsen the symptoms of hidradenitis suppurativa. Try to find activities that don't irritate your skin.
  • Consider altering your diet. Hidradenitis symptoms may be worsened by diets that include dairy, red meat and foods with a high glycemic index.
  • Avoid all tobacco products. If you smoke, try to quit. Smoking and other tobacco use can worsen the symptoms of hidradenitis suppurativa.

Coping and support

One of the greatest challenges of living with hidradenitis suppurativa may be coping with pain and embarrassment. Painful sores might affect your sleep, mobility or sex life. If the sores are draining pus, they can smell, despite good self-care. You might feel anxious and become withdrawn, self-conscious or depressed.

Try to find support among your family and friends. You may also find the concern and understanding of other people with hidradenitis suppurativa comforting. Ask your doctor for a referral to a mental health professional or contact information for a support group.

Preparing for your appointment

You may start by seeing your primary care doctor. He or she may refer you to a doctor who specializes in treating skin diseases (dermatologist). Depending on the severity of your condition, your care may also involve specialists in colorectal surgery, plastic surgery or digestive diseases (gastroenterology).

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment make a list of:

  • Symptoms you've been experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment
  • All medications, vitamins and supplements you take, including doses
  • Questions to ask your doctor

For hidradenitis suppurativa, some basic questions to ask your doctor include:

  • What's the most likely cause of my symptoms?
  • Are there other possible causes?
  • Do I need any tests?
  • How long will my condition last?
  • What treatments are available, and which do you recommend?
  • What side effects can I expect from treatment?
  • Is this condition related to another medical disorder?
  • Do you have any brochures or other printed materials that I can take with me? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

  • When did your symptoms begin?
  • What did the skin lumps look like when they started?
  • Do they come back in the same spots?
  • Are your symptoms painful?
  • Have your parents or siblings ever had this problem?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, seems to worsen your symptoms?
  • Do you smoke or use tobacco products?
May 16, 2019
References
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  2. Ingram JR. Hidradenitis suppurativa: Treatment. https://www.uptodate.com/contents/search. Accessed Jan. 22, 2019.
  3. Orgill DP. Surgical management of hidradenitis suppurativa. https://www.uptodate.com/contents/search. Accessed Jan. 22, 2019.
  4. Ingram JR, et al. Interventions for hidradenitis suppurativa. Cochrane Database of Systematic Reviews. http://ovidsp.tx.ovid.com/sp-3.18.0b/ovidweb.cgi. Accessed Feb. 4, 2019.
  5. Ingram JR. Hidradenitis suppurativa: Pathogenesis, clinical features, and diagnosis. https://www.uptodate.com/contents/search. Accessed Jan. 22, 2019.
  6. Maarouf M, et al. The role of nutrition in inflammatory pilosebaceous disorders: Implication of the skin-gut axis. Australasian Journal of Dermatology. In press. Accessed Jan. 22, 2019.
  7. Shahi V, et al. Prevalence of hidradenitis suppurativa: A population-based study in Olmsted County, Minnesota. Dermatology. 2014;229:154.
  8. Habif TP. Acne, rosacea, and related disorders. In: Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 6th ed. St. Louis, Mo.: Saunders Elsevier; 2016. https://www.clinicalkey.com. Accessed Jan. 22, 2019.
  9. Bolognia JL, et al., eds. Folliculitis and other follicular disorders. In: Dermatology. 4th ed. Philadelphia, Pa.: Saunders Elsevier; 2018. https://www.clinicalkey.com. Accessed Jan. 22, 2019.
  10. Roberts JR, et al., eds. Incision and drainage. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, Pa.: Elsevier; 2019. https://www.clinicalkey.com. Accessed Jan. 22, 2019.
  11. Thorlacius L, et al. Towards global consensus on core outcomes for hidradenitis suppurativa research: An update from the historic consensus meetings I and II. British Journal of Dermatology. 2018;178:715.
  12. Miller IM, et al. Prevalence, risk factors, and comorbidities of hidradenitis suppurativa. Dermatologic Clinics; 2016:7.
  13. Lebwohl MG, et al. Hidradenitis suppurativa. In: Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 5th ed. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Jan. 22, 2019.
  14. Wang SC, et al. Hidradenitis suppurativa: A frequently missed diagnosis, part 2: Treatment options. Advances in Skin & Wound Care. 2015;28:372.
  15. Hidradenitis suppurativa. America Academy of Dermatology. https://www.aad.org/public/diseases/painful-skin-joints/hidradenitis-suppurativa. Accessed Feb. 5, 2019.
  16. Margesson LJ, et al. Hidradenitis suppurativa. Best Practice & Research Clinical Obstetrics and Gynaecology. 2014;28:1013.
  17. Deckers IE, et al. The handicap of hidradenitis suppurativa. Dermatologic Clinics. 2016;34:17.

Hidradenitis suppurativa