What Is Hidradenitis Suppurativa?

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Between 0.03% and 4% of the global population may have hidradenitis suppurativa (HS), a chronic inflammatory skin condition. While those figures mean that HS isn’t rare, it’s not a well-known condition. As a result, many people with it aren’t aware that they may have HS, and people may live with HS for years before getting the right diagnosis. That’s particularly true because the symptoms can resemble those of other conditions, such as cystic acne.

If you understand the signs and risk factors of hidradenitis suppurativa, it’s easier to determine when to see a doctor. Additionally, by learning about the complications that come with HS, you’ll know why proper treatment is essential. Here’s a look at what HS is, the known risk factors, and the potential complications.

Signs and Symptoms of Hidradenitis Suppurativa

According to the Cleveland Clinic, HS is “an autoinflammatory condition of the hair follicles.” Essentially, a person’s body attacks their own hair follicles, resulting in inflammation, scarring, and abscesses.

Typically, one of the clearest signs of HS is the development of nodules under the skin in places on the body where there’s skin-on-skin contact, such as the armpits or groin area. The nodules can appear and disappear, though they typically recur. Infections may happen, especially when the nodules rupture because that potentially exposes them to infectious bacteria. When nodules remain for a longer period, tunnels between the nodules may form under the skin as well.

Along with nodules, you may experience pain, redness, itchiness, and a burning sensation. Additionally, abscesses, which are collections of pus under the skin, can occur. If these rupture, they may release a mix of pus and blood that often has a foul odor.  These infections usually heal slowly — if they heal at all — so it is important to seek proper medical treatment.

Risk Factors for Hidradenitis Suppurativa

Specific risk factors are associated with HS. It is most common among people in their 20s and 30s, and women are more likely to develop the condition than men. A family history of HS increases a person’s risk, as does having certain other conditions, such as metabolic syndrome, diabetes, arthritis, and acne. Individuals who are obese and who smoke are more likely to develop HS. This is important because these are risk factors that can be controlled with lifestyle changes.

Complications of Hidradenitis Suppurativa

When HS is severe and persistent, there are complications that can occur. Infection is possible, as well as scarring and skin pitting. At times, scarring, swelling, and sores may restrict your movement or make movement painful.

Swelling in the arms, legs, and genital area may happen if the nodules impact nearby lymph nodes and interfere with the lymph drainage system. Ongoing HS may also increase your likelihood of developing cancer, specifically squamous cell carcinoma. 

There are also psychological effects of the condition. For some, it may lead to embarrassment or anxiety, particularly if any nodule drainage is producing an unpleasant odor. Ongoing discomfort or the physical appearance of the nodules may also lead to depression.

Next Steps

You should consult with your doctor if you’re experiencing any of these symptoms or are concerned about HS. Your doctor will be able to help you find the right diagnosis and treatment plan, as well as support you with managing the complications of HS. If your doctor finds that your symptoms are not consistent with HS, they can help you work on reducing your modifiable risk factors for this disease. 

Further Reading

  1. Calao M, Wilson JL, Spelman L, Billot L, Rubel D, Watts AD, Jemec GBE. Hidradenitis Suppurativa (HS) prevalence, demographics and management pathways in Australia: A population-based cross-sectional study. PLoS One. 2018 Jul 24;13(7):e0200683. doi: 10.1371/journal.pone.0200683.
  2. Ballard K, Shuman VL. Hidradenitis Suppurativa. [Updated 2022 Jul 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534867/
  3. Cleveland Clinic. “Hydradenitis Suppurativa.” Last reviewed 20 Dec 2022. https://my.clevelandclinic.org/health/diseases/17716-hidradenitis-suppurativa#symptoms-and-causes