Summary

Hidradenitis suppurativa (HS) is a disease that usually begins as pimple-like bumps on the skin. The pimple-like bumps tend to develop in places that everyday pimples do not appear. HS is most common on the underarms and groin. Getting treatment for HS is important. Early diagnosis and treatment can prevent HS from worsening. If HS worsens, the pimple-like bumps can grow deep into the skin and become painful. They can rupture, leaking bloodstained pus onto clothing. This fluid often has a foul odor. As the deep bumps heal, scars can form. Some people develop tunnel-like tracts under their skin. As the skin continues to improve and scar, the scars thicken. When thick scars form in the underarm, moving the arm can be difficult. Thick scars in the groin area can make walking difficult. Because HS can look a lot like acne, folliculitis, or boils, it is best to see a dermatologist for a diagnosis.

Acne inversa or hidradenitis suppurativa (HS) is a disease that usually begins as pimple-like bumps on the skin. The pimple-like bumps tend to develop in places that everyday pimples do not appear. HS is most common on the underarms and groin. Some people say that their HS looks like one of these skin conditions:

• Pimples
• Deep-acne like cysts and blackheads
• Folliculitis (looks like swollen pimple with a hair in the center)
• Boils

Getting treatment for HS is important. Early diagnosis and treatment can prevent HS from worsening. If HS worsens, the pimple-like bumps can grow deep into the skin and become painful. They can rupture, leaking bloodstained pus onto clothing. This fluid often has a foul odor. As the deep bumps heal, scars can form. Some people develop tunnel-like tracts under their skin. As the skin continues to improve and scar, the scars thicken. When thick scars form in the underarm, moving the arm can be difficult. Thick scars in the groin area can make walking difficult. Because HS can look a lot like acne, folliculitis, or boils, it is best to see a dermatologist for a diagnosis. To a dermatologist’s trained eye, the differences between HS and other skin diseases are subtle but noticeable. Proper treatment depends on an accurate diagnosis.

Signs and Symptoms of Acne Inversa 

If you have this skin disease, you may notice breakouts on your skin that look like pimples or boils. Your skin may clear for a while, but you see new breakouts develop in the same area. Unlike everyday pimples, hidradenitis suppurativa (HS) forms in areas where skin touches the skin. HS is most common in these areas:

• Underarms (one or both)
• Groin (genitals, around the anus, and surrounding area)
• Buttocks
• Upper thighs
• Women’s breasts (underneath and sometimes on the breasts)

Although rare, a few studies have found HS near an ear or around the belly button. There have also been a few cases of HS appearing on the face, neck, or back. Women tend to get breakouts on their genitals and upper thighs. Men are more likely to have HS on their genitals and around the anus. Some people develop breakouts in the same spot each time. For others, the breakouts appear in the same area but never seem to be in the same spot.

Early signs and symptoms of Acne Inversa 

When people first get hidradenitis suppurativa (HS), they often see:

• One (or several) breakouts that look like pimples or boils.
• Breakouts may stay on the skin; sometimes, they clear and reappear.

Later signs and symptoms of Acne Inversa

Without treatment, HS can worsen. If this disease progresses, the person may develop:

• Painful, deep breakouts that heal and reappear.
• Breakouts that rupture and leak a foul-smelling fluid.
• Scars that form as breakouts repeatedly heal and reappear.
• Scars become thicker with time.
• Skin begins to look spongy as tunnel-like tracts form deep in the skin.
• Serious infections.
• Skin cancer (rare).

The signs and symptoms of HS can change quickly. One week, a person may have a foul-smelling fluid leaking from breakouts. The following week, the breakouts have cleared, and scars are the only sign of HS. Some people always have breakouts on their skin.

Acne Inversa  and Skin Cancer Risk

HS develops on skin that tends to get little or no direct sunlight. Most cases developed in men who had long-standing HS on their genitals or around their anus. Yet, a few people have developed squamous cell carcinoma, a common type of skin cancer, where they had HS breakouts and scarring for years.

Quality of life For Patients Who Suffers From Acne Inversa

Without treatment, HS can continue its cycle of breakouts and healing. As the breakouts clear, scars form. Continual healing and scarring can cause hollow passages called fistulas to develop inside the body. Fistulas can be painful and require surgery to repair. People who have a foul-smelling liquid draining from the breakouts can feel embarrassed. They may feel too embarrassed to see a doctor. Dermatologists understand this. You should not feel ashamed to see a dermatologist about this problem.

Who gets Acne inversa (Hidradenitis Suppurativa)?

Hidradenitis suppurativa (HS) is most common in:

• Overweight or obese people.
• Three times more common in women than in men.

HS usually begins around puberty. Few people develop HS before 11 years of age. When HS appears before 11 years of age, the child is often experiencing early adolescence. Getting HS after menopause or 55 years of age is rare.

What causes Acne inversa (Hidradenitis Suppurativa)?

No one knows for sure what causes HS. Because it occurs after puberty, hormones likely play a role. The person’s immune system also seems to play a role. HS may develop when a person’s immune system overreacts. HS begins in the hair follicles (where hair grows out of the skin). Like common acne, HS forms when the hair follicles clog with bacteria and other substances. HS may develop in people who have an immune system that overreacts to the plugged hair follicle. Lifestyle also seems to play a role. It seems that smoking, being overweight, or taking lithium may trigger HS. These things do not cause HS. If a person is susceptible to getting HS, any of these could make HS appear for the first time or worsen existing HS. Although the exact cause is still unknown, dermatologists have learned the following from studying HS:

• It is not contagious.
• Poor hygiene does not cause HS.
• About one-third of people who get HS have a blood relative who has HS.

How do Dermatologists Diagnose Acne Inversa (Hidradenitis Suppurativa)?

To diagnose this skin disease, a dermatologist looks closely at the skin and asks some questions. If your breakouts are leaking fluid, your dermatologist may swab a bit of the liquid onto a slide to determine if you have an infection. You also may need a blood test.

How do Dermatologists Treat Acne inversa (Hidradenitis Suppurativa or HS)?

Dermatologists offer patients who have hidradenitis suppurativa (HS) many treatment options, including many different medicines. Surgery may be an option when HS is severe or fails to respond to other treatments. Treatment can help patients with HS:

• Clear or reduce breakouts.
• Get rid of scars and tunnels beneath the skin.
• Prevent new breakouts.

Dermatologists frequently use the treatments listed below, so they have in-depth knowledge and experience using them. Medicines used to treat HS: If you have HS, your dermatologist may include one or more of the following in your treatment plan:

• Antibiotics: This is often part of the treatment plan. These drugs can reduce inflammation, fight infection, prevent HS from worsening, and stop new breakouts.
• Acne washes and medicines: Acne treatments that you can buy without a prescription may be helpful. Using these products alone usually will not clear HS.
• Bleach baths: If certain bacteria colonize (found on the surface of your skin), your dermatologist may recommend taking 5- or 10-minute bleach baths. You’d take this bath in your bathtub at home. If a bleach bath is suitable for you, your dermatologist will tell you how to make one.
• Biologics: These work on the immune system. Some, such as adalimumab, you inject yourself. Others require an infusion at a hospital or clinic. Some patients have seen the long-term clearing of their HS with a biologic. Due to possible serious side effects, you should discuss the risks and benefits with your dermatologist.
• Corticosteroid injection into a breakout: Your dermatologist may inject this into a painful cyst to reduce pain and swelling.
• Corticosteroid pills: This medicine reduces inflammation, which can help clear HS and prevent new breakouts.
• Diabetes drug: Metformin has been approved to treat adult-onset diabetes. It may also help people who have HS and a condition called metabolic syndrome.
• Hormone therapy: Some women relieve by taking birth-control pills, a medicine called spironolactone. These medicines can decrease pain and the amount of fluid draining from the breakouts.
• Methotrexate (severe HS only): This medicine is used to treat cancer and certain other medical conditions, such as severe psoriasis. It works on the immune system and may help control HS in some patients.
• Oral retinoid: A few patients with HS are helped.
• Radiation therapy: This treatment exposes the body to radiation, so it is used less often today than in the past. Some patients have seen their HS clear. Be sure to talk with your dermatologist about the short- and long-term risks to your body.
• Wound dressings: If the HS causes tunnels beneath your skin, you will need to treat these as you would wounds.

When HS grows deep into the skin, medicine alone may not be valid. Your dermatologist may recommend a surgical procedure. The following can an in a dermatologist’s office or clinic:

• Laser surgery: This treatment is showing promise. Some patients clear after several treatments. Lasers are proving effective at clearing new and deep HS breakouts. This treatment may be helpful because it destroys the hair follicles.
• Deroofing: This surgery may be an option for patients who have painful HS that repeatedly returns. The surgeon turns deep, painful HS into scars.
• Drain or incise: The dermatologist drains 1 or 2 lesions during the surgery or cuts them out. This can bring short-term relief, but the HS can return.
• Excision: This involves surgically cutting out the HS and some normal-looking skin. Because the wound is deep, the area needs to be covered with a skin graft (skin removed from another part of your body) or skin flap (skin from nearby is pulled over to cover the wound). HS does not return to the treated area, but it can develop nearby.

No one treatment works for everyone who has HS. Sometimes, a patient needs to try a few different medicines to find one that works.