hidradenitis suppurativa

By Suzanne Vickers, PA

Although underrecognized, we see Hidradenitis Suppurativa (HS) quite often in our practice. It often goes undiagnosed for years. Patients will typically be coming in for another problem and mention that they get cysts or boils under their arms or in their groin. They mention that it has been going on for years and they have been to the Urgent Care clinic many times for antibiotics and drainage. Most people have never been given a diagnosis, and have just had to deal with it for years. On average, people have been suffering with HS for seven years before ever receiving a diagnosis and proper treatment.

It’s time to get a better understanding of this complex condition.

HS is an inflammatory skin condition most commonly affecting the glands under the arms, in the groin, neck, and buttocks. The hallmarks of HS include draining cysts and abscesses with sinus tracts and disfiguring scarring developing in the area. This condition can cause extreme psychological stress and depression. It is more common in women than men, though the actual cause of HS is unknown. There are many factors that play a role in the development and severity of HS, including hormonal factors, insulin resistance, obesity, and smoking.

When treating a patient with HS, all of these factors need to be addressed. Often, during flare-ups, patients will need antibiotics, injections of steroids, oral steroids, and draining of the lesions. We also recommend various antibacterial washes and topicals to cut down on secondary infections. As mentioned earlier, it is imperative to treat the whole disease—not just the flare-ups. With the majority of my HS patients being female, hormonal treatment is key. This is achieved by using oral contraceptives and/or spironolactone. Spironolactone is actually a diuretic used for its antiandrogen properties. It is used quite often for any androgen-driven condition in women, HS, acne, and excess facial hair.

Proper diet is essential to controlling HS. Insulin resistance is hypothesized as the key etiology of the disease. This is a very important part of the puzzle, and patients often notice that when they gain weight, their HS worsens and when they lose weight, it improves. I recommend to all of my patients that they change their eating habits, regardless of their weight. We are finding out that there is a link between inflammatory conditions and diet. Processed foods, high glycemic foods, carbs, and sugars have all been found to be pro inflammatory, so when dealing with an inflammatory condition, like HS, it is important to cut those foods out. I always recommend a diet focused on fruits and vegetables with lean meats, cutting out the carbs, sugar, and processed foods. I also recommend decreasing dairy intake, as dairy has also been linked to flare-ups of HS. In those patients with insulin resistance or metabolic syndrome, a diabetes medication called Metformin can be prescribed in the treatment of HS. Of course, it is extremely important to counsel patients on smoking cessation.   

More recently, a newer class of medications has been studied for the treatment of HS. Biologic medications have been used for years in dermatology for another inflammatory condition, psoriasis, and they are now being studied for HS. As of now, Humira is the only biologic FDA approved for HS, but I imagine that more will be approved in the near future.   

Other treatment options include surgery and laser hair removal.  

I hope this gives you a better understanding of Hidradenitis Suppurativa. If you develop recurring boils and cysts under your arms or groin, please don’t hesitate to call our office to set up an appointment today to start treatment and get your HS under control.