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Hidradenitis Suppurativa

Hidradenitis Suppurativa, or HS, is a long-term disease where inflamed and swollen lumps and abscesses appear under the skin. Typically, these are painful and will break open releasing fluid or pus. The most commonly affected areas are under the arms, under the breasts, and where there are folds in the skin, such as the groin.

HS is believed to start in the hair follicle unit, or the small pockets from which each hair grows. It is unclear why, but with HS, the follicle closes, then expands. As HS gets worse, pustules or pimples can develop, and can further develop into painful cysts, or nodules. If the follicle then ruptures, this will result in an abscess, with skin cells and pus spilling into the lower layer of the skin making tunnels, tracts, and, eventually, fibrotic scars. HS almost always occurs between puberty and age 40, although it has been diagnosed as early as age 5. It is often regarded as a rare skin condition because it is not easily identified and many patients who have HS will not end up getting a diagnosis. A diagnosis can be made through a physical examination and taking a medical and family history. Sometimes a biopsy or skin sample may be taken to rule out other conditions. HS can have a significant negative impact on a person’s quality of life, as many patients with HS fear being embarrassed or stigmatized because of this condition’s symptoms, and may actively avoid social interactions that may expose these symptoms. It is common for patients with HS to have other medical conditions, or be at risk of having other conditions such as obesity, metabolic syndrome, inflammatory bowel disease, arthritis, or depression. HS is not contagious, and not caused by poor hygiene. It is more common in women than men, and often improves in women after menopause.

Some factors that can cause HS flares are:

  • Friction and sweating – Both exercise and excessive sweating may trigger a flare.
  • Clothing – Tight-fitting clothing such as jeans may make your HS worse. Wear loose-fitting clothing that doesn’t sit against the creases in your skin.
  • Weather – HS can be worse in hot, humid summer weather.
  • Weight gain – Some patients have found that their HS will flare when they gain weight, as this can aggravate HS in many ways including increased friction. It has been shown that weight loss improves HS and helps HS management.
  • Smoking – Smoking has been shown to be more common in patients with HS than in the general population, and it may trigger HS flares through different mechanisms.
  • Menstrual cycle (in women) – Some women have observed a relationship between having an HS flare and having their period, or finding that their HS symptoms are worse when they are about to menstruate.
  • Changes in medication usage – Stopping or starting a medication may cause a flare of HS. If this happens, it is a good idea to consult with your doctor.
  • Stress – Managing stress is important to prevent flares, as having a lot of stress, or emotional distress, can produce a flare. HS may also cause a lot of stress or anxiety. Please do not hesitate to seek help to cope with the disease.

There is no cure for HS, and flares may occur often, but the condition can be controlled with proper treatment. This treatment will depend on both the seriousness of the condition, and patient preferences. Some lifestyle modifications, such as managing the factors above, can help control HS symptoms in the early stages. Oral or topical medications such as antibiotics are commonly prescribed. Other treatments include injections of corticosteroid to control inflammation in the short term, therapies called anti-androgens that target the hormones in the body, or other oral therapies called systemic immunosuppressants. More recently, biologic therapies used to regulate the immune system are also being used to manage HS.

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