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Diseases

Genetic and Rare Diseases Information Center (GARD)

Hidradenitis suppurativa

*

* Not a rare disease

Other Names for this Disease
  • Acne inversa
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Your Question

My friend has hidradenitis suppurativa. Can you please help me find more information?

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What is hidradenitis suppurativa (HS)?

Hidradenitis suppurativa (HS) is a chronic skin disease characterized by recurrent, painful, boil-like lumps (nodules) under the skin. HS affects the areas around skin folds (e.g., armpits, groin, and breasts) and where apocrine glands (a form of sweat gland) and hair follicles are found. It is not contagious, but it is recurrent. It typically manifests as a single boil-like, pus-filled abscess or hard sebaceous lumps (lumps composed of sebum, or oil, which is excreted by the sebacous glands associated with hair follicles) and may progress to painful, deep-seated, inflamed clusters of lesions with chronic seepage involving significant scarring.[1] In most cases, the cause of HS is unknown. It is likely that it results from a combination of genetic and environmental factors. Some cases of HS have been associated with specific genes, including NCSTN, PSEN1, and PSENEN.[2] 
Last updated: 3/6/2015

Who is most likely to be affected by hidradenitis suppurativa?

HS occurs more commonly in women and usually occurs in the third decade of life. [3]
Last updated: 7/2/2013

What are the signs and symptoms of hidradenitis suppurativa?

Hidradenitis suppurativa is characterized by:[4]

  • Small pitted areas of skin containing blackheads;
  • Red, tender bumps or lesions that enlarge, break open and drain pus that may have an unpleasant odor; 
  • Painful hard lumps that develop under the skin and may enlarge and/or persist for years; and 
  • Leaking bumps or sores that heal very slowly and can lead to scarring and tunnels under the skin (called sinus tracts).

Hidradenitis suppurativa commonly occurs in areas near hair follicles where there are many oil and sweat glands; places like the armpit, groin and anal area. It can also occur in areas where skin rubs together, including the inner thighs, under the breasts, and between the buttocks.[4][5]

This condition most often presents after puberty and can persist for years, worsening over time. Three stages of disease have been described which progress from single or localized abscesses accompanied by itching or discomfort, to recurrent abscesses that occur in multiple locations, to widespread severe disease that can restrict movement, obstruct lymph drainage and lead to social isolation.[5][1]

Last updated: 10/6/2015

What causes hidradenitis suppurativa?

The underlying cause of hidradenitis suppurativa (HS ) is not known in most cases. Researchers suspect that there may be several potential underlying causes of genetic, endocrine, microbiological, and environmental origin.[3][6]

A family history of HS is reported in approximately 1/3 patients. Researcher suspect that HS is inherited or passed down in an autosomal dominant manner. This means that if an individual inherits HS, they have a 50% chance to pass it to the next generation. These risks may be lower, as there are likely other influences that impact one's likelihood of developing HS. Researchers are currently trying to identify which genes may be implicated in HS. Some cases have been found to result from mutations in the NCSTN, PSEN1, or PSENEN gene. More studies are needed to determine whether other genes might be involved.[6][2]

Last updated: 7/6/2016

How might hidradenitis suppurativa be treated?

There is no known cure or a consistently effective treatment. Initial treatments may involve conservative measures such as warm baths, hydrotherapy, and topical cleansing agents to reduce bacterial loads. Acute painful skin lesions may be treated with corticosteroids (e.g., prednisone) or anti-inflammatory pills (e.g., Celebrex, Advil, Naproxen, and others). Although not proven to be effective, antibiotics are often the mainstay of medical treatment, especially for lesions suspected of being super infected. Affected individuals may also be treated with oral contraceptives or other medications that address a possible hormonal cause. Oral retinoids such as isotretinoin have also been used. Other treatments that have been used with limited success include cisplatin, methotrexate, 5-alpha reductase inhibitors, and TNF-alpha inhibitors.[1][3][7]

In advanced cases, affected individuals may undergo surgery (e.g., laser therapy or photodynamic therapy), but recurrences of HS are not uncommon. Systemic therapies are still being researched. The goals of these therapies are to heal existing lesions and prevent the development of new lesions in the areas potentially affected by the disease.[1][3][7]
Last updated: 3/6/2015

References
Other Names for this Disease
  • Acne inversa
See Disclaimer regarding information on this site. Some links on this page may take you to organizations outside of the National Institutes of Health.