UNC Health Care
Young woman looks into mirror, focused on a blemish on her cheek

HS 101: What You Need to Know About Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic, painful skin condition characterized by chronic inflammation of the hair follicles that cover the body.

The first sign that most people notice is a tender, raised, red bump that looks similar to a pimple. Over time, more of these bumps appear. They get bigger and break open, leading to the development of abscesses on areas of the body where skin contacts skin: under the arms, around the buttocks, between the anus and the genitals, and between and under the breasts. The abscesses drain fluid and pus, and they may itch and have an unpleasant odor.

These abscesses can be quite painful and long-lasting, and they can lead to the formation of sinus tracts (drainage tunnels) under the skin, and scarring. In the most severe cases, people with HS may have scars that limit their ability to freely move their arms and legs, but this is rare. Living with the disease can be difficult, and because of this people with HS may also be at risk for depression and anxiety.

Fortunately, there are several treatment options available. To find out more about HS and how it is treated, we spoke with Christopher Sayed, MD, a UNC Health dermatologist who specializes in HS and other follicular disorders and serves as one of the medical directors for the NC Triangle chapter of Hope for HS.

What Causes HS?

“The cause of HS is not completely understood,” Dr. Sayed says. “It seems to be a chronic inflammatory disorder of hair follicles and often many family members are affected, so genetics probably play a strong role.”

Hormonal fluctuations likely play a part; the condition typically starts around puberty when hair follicles under the arms and in the groin start to change. It can sometimes flare with menstrual cycles.

Cigarette smoking and obesity are known to contribute to HS flaring and worsening but are only part of the picture since many nonsmoking patients who are not overweight also develop this disease. For some patients, quitting smoking, losing weight, and eating a diet low in sugar and fats may be helpful in improving HS, but these measures aren’t helpful for everyone, Dr. Sayed says.

HS affects between 0.7 percent and 1 percent of the population in the United States, Dr. Sayed says. It is most common among women, those between 30 and 39 years old, and among African Americans and people who are biracial. In most cases, HS lasts for decades and starts to improve to some extent in the late 30s and 40s.

“It is important to understand that HS is not contagious,” Dr. Sayed says, “and it is not caused by a problem with personal hygiene or any other activity or behavior of those with the disease.”

How Is HS Treated?

Both medications and surgery are used to treat HS.

Doctors treating HS commonly prescribe antibacterial skin washes and topical antibiotics to prevent secondary infections, and inject corticosteroids into the lesions to reduce inflammation.

Immunosuppressants (such as methotrexate, adalimumab/Humira, and infliximab/Remicade), hormonal therapies such as oral contraceptives, steroids and oral antibiotics all may be used to fight HS symptoms.

“Laser treatments that destroy hair follicles can be helpful, since they reduce the hair follicles that cause the problems,” Dr. Sayed says. “Multiple treatments are typically required over time, and there is some discomfort associated with treatment, but it is typically very fast and well-tolerated.”

Several different surgical methods have been developed for HS, focusing on removing diseased skin and eliminating drainage tunnels. If the disease is not too advanced, the patient may be treated in an outpatient procedure using local anesthesia; when the disease is more extensive, general anesthesia is required and the patient may need to begin the healing process in the hospital.

What Can You Do on Your Own to Help Your HS?

Some lifestyle changes can help reduce the painful symptoms of HS for some people. If you are a smoker, then quitting smoking will probably be helpful, Dr. Sayed says. It probably will not completely reverse all of the effects of HS, but it can slow down the progression and make it easier to treat. Your dermatologist should be able to refer you to a cessation program or counselor to help with this.

Dr. Sayed also recommends that HS patients:

  • Follow a healthy diet and try to achieve a healthy weight.
  • Keep their skin cool and dry (becoming overheated and sweating can contribute to an HS flare).
  • Apply hot compresses or soak their bodies in hot water for 10 minutes at a time (use a clean washcloth) to reduce the pain of cysts or nodules or to help them to drain.
  • Wear cotton, comfortable underwear that isn’t too tight and avoid elastic bands. Boy-short styles of underwear are often the least irritating.

If you are experiencing skin irritation, contact your dermatologist. Need one? Find one near you.