Everything You Need to Know About Hidradenitis Suppurativa

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This disease almost sounds like a science-fiction creation and it’s very certain that most of us haven’t heard about it. The name of the disease is long and pretty hard to pronounce. To facilitate its discussion, let us abbreviate hidradenitis suppurativa and refer to it as HS.

Two people are accredited for its discovery. First, in 1839 by Alfred Velpeau who was a French physician. Then, in 1854 by Aristide Verneuil. Because of this, HS has also been referred to as Velpeau’s or Verneuil’s disease. It’s believed that Karl Marx suffered from HS, which could have hindered him in his writings. It’s only recently that the HS has been recognized and acknowledged. As it’s considered a rare disease, many medical professionals are still unaware of its existence.

HS is truly a rare disease and it affects people in parts of their bodies where a lot of contact or friction occurs. These areas include the armpits, anal, and groin areas and in women, the areas just underneath their breast. HS affects women more than men. Also, their symptoms usually appear after puberty. The disease is characterized by the appearance of painful bumps underneath the skin which can cause discomfort for long periods of time. No one really knows how the disease starts. For certain, it’s not contagious and it’s not caused by poor hygiene. We shall try to examine the symptoms of HS, its causes, and the available treatments that have been developed to alleviate its painful effects.

Causes and Risk Factors for Hidradenitis Suppurativa

The usual areas where HS occurs are in the hair follicles which are close to the sweat and oil glands. When there is constant friction in such areas, HS may start manifesting itself. Up to the present, doctors still don’t have a clue how HS comes about. It’s only known that the disease is not contagious, it’s not caused by poor hygiene and is not caused by some other infection. Here are some probable causes of HS:

  • Some studies have indicated that there is a genetic link to the disease. It has been noted that a third of those who carry HS have members in their families carrying the disease as well.
  • Other studies also show that mutations in specific genes can cause HS. However, this is not yet conclusive and more research is needed to be done.
  • The occurrence of HS shortly after puberty can be an indication that hormones are likely to be involved in the development of the disease.

Experts are still in a quandary in explaining the occurrence of HS because there are too many factors and variables involved. Some are certain that the eventual blocking of hair follicles causes inflammations which could develop into uncomfortable bumps or tunnels in a person’s skin.

However, it’s still a challenge to pinpoint what really causes HS. As aforementioned, it’s not even an issue of cleanliness because people who practice good hygiene aren’t spared from the disease. Hair follicle blockages may occur in everybody but only some can develop the disease. As mentioned earlier, there are too many factors which can contribute to the disease’s development. Here are some factors that can increase the risk of developing HS:

Genetics. People who have a family history of HS have a higher risk of developing the condition as against those who have no history. Because of this, it’s safe to make an assumption that genetics plays a key role in HS.

Age. Most of those who have HS are aged 20 and above. But anybody can still contract the disease after puberty and even into the 40s.

Sex. Studies have shown that women are more affected by HS than men. This may be because women develop larger hips and breasts, allowing more follicle growths to be exposed to consistent rubbing and more possible blockages.

Smoking. This is a disgusting habit that has also been linked to the development of HS.

Other Diseases and Conditions. Many of those who develop HS has also been exposed earlier to other health and skin conditions. Such conditions can include metabolic syndrome, inflammatory bowel disease or IBD, Crohn’s disease, severe acne, diabetes, obesity, and others.

Symptoms of Hidradenitis Suppurativa

There are already some known facts about HS. For instance, we know that the disease prefers to thrive in some specific areas of the body like the groin, buttocks, armpits, and breast. Also, HS can affect multiple body parts and might even get worse after some time. In some cases, people can contract HS but only with mild symptoms and the condition don’t seem to bother them. Here are the most common symptoms of HS:

Tender Bumps. This is the first of two types of bumps that may develop with HS. The bumps are typically filled with pus which can burst as time goes by because of constant rubbing or friction. The pus will emit odors that many deem unpleasant.

Large and Painful Bumps. This is the second type of bumps and they are typically hard. They are pea-sized and may last longer than the tender type. They may grow even bigger and can get inflamed when subjected to rubbing or are irritated.

Tunnels Underneath the Skin. Multiple bumps can develop in a single area and these are usually connected by tracks underneath the skin called tunnels. These tunnels can be tenacious as they are really a challenge to get rid of. Moreover, these tunnels can contain pus like the tender bumps. It will take the body long periods of time to heal such tunnels, that is if they ever heal at all.

If one should experience any of these HS symptoms, he should consult with his doctor immediately so he can recommend the most appropriate treatment options.

Diagnosis of Hidradenitis Suppurativa

An early diagnosis of HS will ensure effective treatments that could prevent limitations of movement and scarring. It’s highly recommended to consult with a dermatologist if one suspects that he has HS. Dermatologists are doctors who specialize in skin diseases.  Initially, the doctor will do a physical examination of the skin and may take swabs on some of the lesions to see if they are leaking fluids. Again, consult with a dermatologist if one develops any breakouts which are:

  • painful
  • don’t improve or heal within two or three weeks
  • appear in different areas in the person’s body
  • the breakouts recur frequently

Treatment Options for Hidradenitis Suppurativa

Although there is still no known cure for hidradenitis suppurativa, there are already available treatment options that can help alleviate the effects of the disease and this can include:

Medications. Usually, doctors can prescribe various medications which may help reduce the symptoms of HS. These include:

  • Steroid medications which can be injected into the bumps directly or can be taken orally. Either method can reduce the inflammations caused by HS.
  • Medications for pain can be administered as well and this can handle the discomfort caused by the bumps.
  • Immunosuppressants can also help in reducing HS symptoms.

Antibiotics. These medications can also be used to reduce inflammations, treat any infections, and prevent any new outbreaks from cropping up.

Biologics. These are preparations synthesized from living organisms or their products and are used as a diagnostic, preventive, or therapeutic agent. The FDA has approved certain biologic medicines to help treat HS.

Steroids. These can be administered by injection or orally. They can reduce inflammations and reduce other HS symptoms. However, long-term use isn’t recommended as it might lead to adverse side effects.

Medications for Pain. The discomfort and pain caused by the skin break-ups can be reduced using over-the-counter pain relievers.

Hormones. Some studies had indications that hormones can have the same effect as antibiotics in the treatment of HS sores but further research needs to be made on this point.

Metformin or Glucophage. This drug is better known in treating diabetes but can help as well on those with HS and also have metabolic syndrome.

Retinoids. These medications derived from vitamin A can also be used either topically or orally.

Methotrexate. This is used only in the treatment of very severe HS cases.

Zinc. Many of those who took zinc supplements reported improvements in their HS symptoms.

Topical Treatments. Ointments, lotions, and other types of creams containing antibiotics have been effective in the treatment of HS.

Topical Medications and Acne Washes. These products are not a guarantee to clear HS symptoms but they can be added to one’s treatment regimen.

Surgery. This method has been recommended by many medical professionals in treating or removing tunnels and also preventing the tunnels from affecting a bigger part of the body than it already has. In certain instances, skin grafts are used to help with the treatment of the disease.

At times, surgery may be required to remove or drain lesions that are growing under the skin. Radiation and laser therapy are unroofing are other procedures that can be used to treat HS. Unroofing refers to an operation which will involve removing the skin which covers tunnels.

Bleach Baths. Taking this kind of bath can help eliminate microorganisms that are present on the skin which can bring about infections. Just follow the steps to make a simple bleach bath:

For every 4 cups of water, add approximately a third teaspoon of a common household bleach. Soak in the bleach bath for up to 15 minutes, while making sure that the head is above the water. After the bath, simply rinse oneself in warm water then pat the skin dry.

The treatment plan to be adopted will depend upon the severity of the person’s HS condition. One may be needing more than a single type of therapy over time. Remember that this disease can cause a lot of discomforts and should be avoided by all means. Although the disease is rare, it can affect anybody over the course of their lives. There’s no permanent cure to HS but there are ways to reduce the disease’s symptoms and make living with HS a lot more tolerable.

Possible Complications of Hidradenitis Suppurativa

When one feels he has developed HS, see the doctor immediately. Leaving the condition untreated can lead to further complications. This can include:

Scarring. Scars will form where the breakouts heal then reappear. Over time, such scars can thicken.

Immobility. A person’s ability to move around may be impaired by painful scars and sores.

Problems with Lymph Drainage. The scars and bumps that are caused by HS usually appear on the areas of the body where the lymph nodes are located. This can have an effect on lymph drainage which, in turn, might bring about swelling.

Changes in the Skin. The color of the person’s skin around the bumps can appear darker or pitted.

Depression. One can only imagine what it could be like if he is subjected to unpleasant odors from drainage and skin breakouts. Definitely, this could result in self-induced isolation and that could further lead to depression.

Fistulas. The cycle of healing and scarring that’s associated with HS breakouts can result in the development of hollow passages inside the body. These are known as fistulas and can cause much pain. Surgery may be required for such cases.

Skin Cancer. In very rare instances, persons who have severe and advanced HS can develop squamous cell carcinoma which is a type of skin cancer.

Living with HS isn’t easy and can be a challenge. Fortunately, there are now effective treatment therapies which may help lessen the pain and also improve the symptoms of the disease. The search for a cure continues and hopefully, there could finally be a breakthrough that can eliminate this disease from our lives.

How Diet Affects Hidradenitis Suppurativa

HS is also known as acne reversa and, as we have mentioned earlier, this is a disease that affects the body areas which have sweat or oil glands. The underarms, buttocks, and groin are the usual targets. HS can cause the appearance of inflamed sores or skin lesions which may cause a lot of discomfort and pain.

We have yet to find out what causes HS. Some markers have linked genetics, sex, and age, especially after puberty as factors that may cause HS. Since everybody is susceptible to the disease, even the most hygienic ones, avoiding HS becomes tough. Luckily, there are many things a person can do to help soothe the symptoms of HS, thus preventing any flare-ups. See the doctor for available treatments, which can include laser treatments, taking antibiotics, and even surgery.

Our diets can also contribute to the incidence of HS. For one, overweight or obese people with HS can be subjected to worse conditions. For them, they will need a change in lifestyle, a healthy diet, and regular exercise. They will need to aim for an ideal weight.

The types of food one consume will have an impact on HS flare-ups. There are certain foods which can reduce skin inflammations and can balance hormones. Of course, we already know that a healthy diet is also good for our overall health. But we need to maintain these diets to lessen the frequency of skin flare-ups. HS can be almost similar to chronic conditions like diabetes, where we abide by diets that would maintain our sugar levels.

Dairy. Although most people love dairy products, they, unfortunately, are not conducive to those who have HS. Milk and other kinds of dairy products might increase the levels of some hormones that can cause HS. Cow’s milk is believed to cause certain inflammations. To be sure one doesn’t increase the risk of developing HS, all type of dairy products should be avoided. Take the following off the grocery list:

  • butter
  • buttermilk
  • cheese
  • cottage or cream cheese
  • cow’s milk
  • yogurt

Sugar-Rich Foods. These types of foods, especially refined simple carbs might cause spikes in the blood sugar levels, specifically glucose. Such spikes can trigger inflammations and can result in HS symptoms. Cross the following simple carbs out of the grocery list:

  • boxed cereals
  • bread, pasta or rice made from white flour
  • candy
  • chocolate or protein bars
  • cookies, crackers, and biscuits
  • corn syrup, especially the high fructose variety
  • doughnuts, cake, and other kinds of pastries
  • noodles
  • potato chips
  • table sugar
  • sodas and other types of sugary drinks such as fruit juice
  • white flour

Brewer’s Yeast. Some medical studies have indicated that brewer’s yeast can trigger the occurrence of HS symptoms. The yeast can cause a reaction in the immune system. Read the food labels of the items on one’s grocery list and cross out everything that might contain this component including:

  • beer
  • fermented spreads
  • some types of bread, pizza, and cakes
  • some types of canned or dried soups
  • some types of dips and gravies
  • some types of health supplements
  • some types of salad dressings and vinegar
  • some types of soy sauce
  • some types of stock cubes
  • wine

Other Factors. Scan through this list to find out if one is involved in any. If one is, it’s time for a change in lifestyle:

  • smoking cigarettes or tobacco
  • excessive weight gain or obesity
  • ingesting foods that contain gluten if one is gluten intolerant

On the other side of the scale, there are also foods that can help with HS symptoms. These include:

Fiber-Rich Foods. Try to incorporate in one’s diet foods which are rich in fibers as these can help in balancing hormone and blood sugar levels. A fiber-rich diet will make one feel full quicker and will reduce the cravings for unhealthy foods. Consequently, it will help a person achieve a healthy weight. It’s time to replace those simple sugary carbs with complex carbohydrates and whole foods such as:

  • barley
  • beans and lentils
  • bran
  • brown rice
  • couscous
  • fresh or dried herbs
  • fresh or frozen vegetables
  • fresh, frozen or dried fruit
  • oats
  • quinoa
  • whole-grain pasta
  • whole-wheat bread

Omega-3 Fatty Acids. Include foods rich in Omega-3 fatty acids because these can help reduce inflammations within the body. Such actions will soothe or prevent inflamed sores. But there’s still a need for further studies if Omega-3 fatty acids have any influence on HS. In the meantime, adding the fatty acid can benefit the blood vessels, the brain, and the heart. Add these foods to the grocery list:

  • avocados
  • chia seeds
  • flaxseed oil and flaxseeds
  • navy beans
  • olive oil
  • pumpkin seeds
  • salmon
  • sardines
  • walnuts

Natural Sweeteners. Sugars are not all that bad, especially if they’re naturally derived. A person can indulge himself once in a while with some sweet beverages and desserts but choose only those which contain natural sweeteners so the levels of blood sugar won’t spike dramatically. Replace the table sugars and other kinds of high-calorie sweeteners in one’s diet. Instead, consider the following:

  • monk fruit
  • stevia
  • sugar alcohols such as xylitol and erythritol

Some diets have recently become popular in treating HS symptoms. The Whole30 and Autoimmune Protocol diets are among the popular ones. There has been good feedback on the effect of these diets on people with HS. This is because such diets don’t allow foods like refined carbohydrates and dairy which have been clinically proven in triggering HS symptoms.

But these diets can also be restrictive and extreme. Moreover, there isn’t really that much evidence that a Paleo diet actually works and it being a long-term solution is still to be proven. Popularity isn’t a measure of effectiveness, so don’t make abrupt changes by following diets that are too restrictive. Furthermore, the restrictions may deprive a person of the many daily nutrients that he requires.

Many researchers have agreed that excessive weight gain and obesity are associated with the development of HS. If one needs more information on this, talk to the doctor about any weight-loss plan. To reiterate, there is no cure for HS. We can only rely, at this time, on medical treatments along with some healthy lifestyle choices. The treatments include laser therapy, medications, and protective silicon bandages which can help relieve swelling, pain, and skin irritations which can always recur anytime. Although eating the right foods may help alleviate the discomforts of HS, more studies are required to prove that diets can indeed help those who have HS. One can try an elimination diet plan which involves checking foods that can influence HS:

  • Eliminate one food item at a time such as simple carbs or dairy from one’s diet for about a month or so.
  • Keep a log of everything eaten and record any symptom changes.
  • Gradually bring back the food item into the diet.
  • Observe for any symptoms then discuss the results with the doctor.

If one needs to do this plan, remember that dietary changes may take months to manifest any improvements. A person’s diet plans should be for the long haul, making it part of his lifestyle. Make it a permanent choice and not something temporary.

Tips for Managing or Living with Hidradenitis Suppurativa

As we’ve discussed, HS, also known as acne reversa is a painful and chronic skin disease that causes skin scarring and abscesses. It first starts like a small blackhead then forming lumps which have the same appearance as boils. It has often been mistaken as acne but as HS gets worse, the boils become deeper and can even start to create grooves on the skin which may start to leak pus. The favorite growing places of this nasty condition are the armpits, the groin, anal, and the buttocks areas.

We’ve also talked about how there’s no cure for this condition but one can still resort to treatments that can encourage pain relief, wound healing, and prevent new lumps from forming. In case the condition worsens, contact the doctor immediately, especially if any of the lesions should show some infections. The doctor may recommend the use of antibiotics. He may also advise him to use antiseptic washes, retinoids, and more. For milder cases, one can keep HS under control with natural and simple measures. These include:

Applying a Warm Compress to Help Drain the Pus so as to Reduce the Pain. Applying heat on the boils may help soothe the symptoms of HS. Simply soak a washcloth that’s clean in hot water and use this as the compress. Gently place this on the lump twice daily. This will ease the pain at the same time drain any pus out of the boil.

Using a Warm Teabag to Alleviate the Pain. This is effective since tea has analgesic and anti-inflammatory properties. Steep the teabag in hot water first for about sixty seconds. Then apply this to the painful cysts or nodules. Leave it for up to ten minutes. This will let the tannin component in the tea do its job.

Dabbing on Tea Tree Oil That’s Been Diluted for Disinfecting the Boils. To inhibit bacterial growth on the infected areas, antiseptic skin washes and soaps are usually recommended, especially for HS cases. Tea tree oil is a natural alternative which has antimicrobial properties. Some studies conducted on tea tree oil have shown that it can have significant effects on boils similar to benzoyl peroxide, an antiseptic, which coincidentally, can also be used to treat HS. Just dilute the tea tree oil with a type of carrier oil and apply directly to the affected areas. Just to make sure no complications should happen, perform a patch test to see that one isn’t allergic to the potent oil.

Using Turmeric to Help Prevent Inflammation. Turmeric, another exotic and miracle spice, has been traditionally used through the ages because of its medicinal properties. It contains a strong antioxidant called curcumin which is an antimicrobial and anti-inflammatory agent. One can take curcumin orally to fight HS from within. Turmeric tea is the most common way of getting a curcumin dose. Have turmeric tea every day or add this spice to the daily cooking for flavoring. One can even make a paste with antibacterial benefits by simply mixing turmeric powder with some water. This is a remedy that has been used to heal boils and treat acne. Rinse the paste off once it has dried.

Try the Elimination Diet. Diet can play an important role when dealing with HS. Studies have shown that diets that do not contain dairy products and was low on the glycemic scale were able to reduce HS symptoms. The sex hormones of males and females seem to also have an effect on the growth of HS lumps. Foods which have a high glycemic index raise the levels of insulin while dairy products may stimulate IGF-1 production which is a type of protein.

One can try the elimination diet to find out if foods with a high GI, gluten, and dairy have any effects on HS symptoms. Remove these foods from the diet and observe if the HS symptoms improve. After some time, re-introduce them one group at a time so one can identify what triggers the symptoms.

Consume a Lot of Foods Which Are Rich in Zinc. Zinc is an essential nutrient which assists our immune system. It’s also utilized by the body for healing wounds, in DNA synthesis, and in managing HS. A study conducted on people who suffer from HS were given doses of zinc gluconate and results were very promising as there were great improvements in the patients, some even went into complete remissions. These beneficial effects were attributed to the ability of zinc to reduce inflammatory reactions of the skin. Some great sources of zinc include poultry, oysters, crabs, red meat, and lobsters.

Lose Some Weight If One Is Overweight or Obese. Being obese can contribute to the frequency of flare-ups on those with the HS condition. The most logical way to avoid this from happening is losing the extra poundage. Even just a 10% decrease in a person’s body weight can already make a significant Keep in mind though, that sudden weight changes can lower the immune system and increase the risk of flare-ups for those with HS.

Quit Smoking. Smoking is hazardous to one’s health. It destroys the respiratory system and can worsen the symptoms of HS. If one quits, hopefully right away, the symptoms’ severity and the occurrence of the flare-ups can be reduced. If one is having difficulties in quitting, he can always seek the advice of healthcare counselors.

Avoid Shaving the Irritated Skin or Using Perfumes and Tight Clothes. One of the main causes of HS is continuous friction on the skin. Logically, it would be the best advice to avoid tight clothing. Wear loose clothing as they are more comfortable. Also, avoid shaving the affected areas and stop using perfumes and deodorants which may exacerbate the condition of the skin.

Avoid Overheating.  Remember that sweat and heat can trigger flare-ups. Avoid going to hot places where the risk of sweating becomes high. Dermatologists can recommend antiperspirants but using this during breakouts can be too harsh. If in case one really needs to use an antiperspirant, talk to a dermatologist and find a product that might best suit him.

FAQs About Hidradenitis Suppurativa

Hidradenitis suppurativa or HS affects people differently so it’s quite difficult to describe what the condition will be like exactly. The good news is that there are some treatments available as well as ways one can manage the condition. Before doing so, it’s important to understand HS more. Here are some common questions about HS:

How Long Will a Person Have Hs? As aforementioned, there’s no available cure for HS so one will have to live with the condition and learn how to manage it for life. Usually, living with HS means that one would have to go through periods of clear skin and periods of flare-ups.

Will Hs Get Worse? HS is considered as a progressive condition which means that it may worsen over time. For instance, it may start as a small pimple then after a few days (or even hours), it might turn into a huge boil. When the boil bursts under the person’s skin, infection and inflammation may quickly spread. The best thing one can do is seek treatment for the condition so he can prevent the manifestation of the severe symptoms.

How Frequently Should One Visit the Doctor? The symptoms of HS and how one’s body will respond to treatment will depend on how frequently he visits his doctor. For those who have mild symptoms, they may manage the condition on their own. But if one needs to take medication which is either injected or administered through a vein, he may have to visit his doctor regularly.

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