Boil
Painful, deep inflammation of a hair follicle caused by bacteria.
Inflammatory
Medically reviewed by Dr. A.M. van Coevorden, dermatologist
± 4 min read
Hidradenitis suppurativapainful, recurring inflammation in the skin folds
Hidradenitis suppurativa, also called acne inversa, is a chronic, acne-like inflammation of the skin in the body folds, mainly the armpits and groin. Painful inflammations develop that can burst open and over time leave scars and tunnels (sinuses) in the skin. It is not contagious, usually starts around puberty and affects about 1% of adults.
What is hidradenitis suppurativa?
Hidradenitis suppurativa (also acne inversa) is an acne-like inflammation of the skin, usually in the body folds, mainly the armpits and groin. It usually starts during or after puberty, often between twenty and twenty-five, and affects about 1% of adults, women more often than men. It is an unpleasant condition, because of the pain of the inflammations, the disfiguring appearance and the sometimes unpleasant smell.
How do you get hidradenitis suppurativa?
Hidradenitis suppurativa starts as an inflammation of the hair follicles when the outlet becomes blocked; sebaceous and sweat glands can also become inflamed. The exact cause is unknown. Various factors may play a role: there is a clear link with smoking, many female patients are overweight, male sex hormones appear to matter (without women with the condition having too much of them), and heredity probably contributes. Bacteria can be cultured from the inflammations, but whether they cause the condition is unknown, and routine cultures are not done.
What does it look like?
Characteristic are painful inflammations in the body folds, mainly armpits and groin, but also under or between the breasts, the pubic area, the scrotum, the labia, around the anus and the buttocks. An inflammation first resembles a small boil, grows larger and deeper and can burst open, releasing sebum and pus. Healing can leave scars, and over time tunnels form in the skin (sinuses or fistulas), along with large blackheads, cysts and abscesses. The discharge can cause an unpleasant smell.
Is it contagious?
N
No. Hidradenitis suppurativa is not contagious.
How is the diagnosis made?
The GP and dermatologist usually make the diagnosis directly from the symptoms and appearance. Occasionally a piece of tissue is removed under local anaesthetic to rule out other conditions.
What treatments are there?
No treatment resolves the condition quickly and permanently, and even after success it often returns; a combination is usually the best approach.
Local: good hygiene is recommended. For folliculitis in particular the doctor may advise antiseptics; abscesses and deeper inflammations do not respond to these. Resorcinol cream can prevent new inflammations and shrink existing ones. For mild activity, laser hair removal of the area is an option.
Antibiotics: most patients are treated with antibiotic tablets, usually tetracycline, doxycycline, minocycline or a combination of rifampicin and clindamycin, for two to four months. They suppress the inflammation temporarily but do not clear fistulas and existing abscesses.
Surgery: an abscess can be opened with an incision to drain the pus. Deeper inflammations and fistulas are cut out (excision), sometimes with a skin graft, or treated with deroofing, in which the skin over the tunnels is burned away. A CO2 laser can also vaporise inflamed tissue. Scarring and recurrence are part of it.
Other medicines: for a sudden severe flare, a short course of prednisolone can be given, often with antibiotics. Women are sometimes treated with a contraceptive pill containing cyproterone acetate. In some cases dapsone or acitretin is used, with blood monitoring. For severe cases that do not respond enough to other therapy, there are biologics such as adalimumab or ustekinumab, subject to strict conditions and often combined with surgery.
What can you do yourself?
Do not wear tight or chafing clothing. Stopping smoking and losing weight can contribute to improvement; the GP can point you to support for quitting smoking and to lifestyle guidance. After surgery it is important to keep moving in moderation to prevent stiffness during healing; a physiotherapist can help.
What is the outlook?
The long-term outlook varies. Symptoms can usually be reduced, but the condition cannot be cured completely.
Frequently asked questions about hidradenitis suppurativa
Is hidradenitis suppurativa contagious?
No. It is a chronic inflammation of the skin and does not pass from person to person, even though pus is sometimes released.
What causes it?
The exact cause is unknown. Smoking, being overweight, hormonal and hereditary factors may play a role. It starts with a blocked hair follicle that becomes inflamed.
Will it ever go away completely?
The condition cannot be cured permanently, but symptoms can usually be reduced with a combination of treatments.
What treatments are there?
Antibiotic tablets, local treatments and laser hair removal, surgery for fistulas and abscesses, and biologics for severe cases.
Does stopping smoking help?
Yes, it can contribute to improvement, as can losing weight. The GP can offer support with both.
Sources and more information
Source: Dutch Society of Dermatology and Venereology (NVDV).