What is a Hidradenitis Suppurativa (HS)?

Hidradenitis Suppurativa (HS), sometimes referred to as acne inversa, is a chronic skin disease that is characterized by pea-sized to marble-sized lumps (called abscesses) under the skin. It’s typically found in areas where the skin tends to rub together such as the underarms, between the breasts, buttocks, and groin area. These lumps are painful and can break open and drain, resulting in long-term skin infections. When left untreated, these lumps can also form connecting tunnels underneath the skin between the abscesses and further exasperate the problem.

Symptoms for Hidradenitis Suppurativa (HS) can be broken in two categories: Early Signs/Symptoms and Later Signs/Symptoms. Your HS symptoms will vary depending on the stage of your disease.

Early signs of HS typically start in a patient’s teenage years. Patients will first start to experience one or more breakouts that look like pimples or boils. This breakout may remain on the skin, but sometimes they will clear, and reappear.

Early symptoms can appear like traditional acne type symptoms, so if a patient suspects their acne is really HS it’s important to have a conversation with their board certified dermatologist or plastic surgeon who specializes in surgery for HS to obtain an accurate diagnosis.

Patients usually start to see clearer signs that they have HS after their teenage years. Later symptoms include deep, painful breakouts that then heal suddenly and reappear. They’re typically found in areas where the skin rubs up against itself such as the underarms, between the breasts, buttocks, and groin area. As the disease progresses, patients can start to develop tunnels underneath the abscesses that are characterized by a spongy type appearance. Scaring can also form after a breakout heals and in some cases these scars can become thicker overtime.  

It’s common for a foul odor to develop during the later stages of HS. The odor is actually caused by the abscesses that develop which eventually break and release a foul smelling odor

Yes! HS can rapidly evolve overtime and different patients can experience different symptoms. For example, some patients will experience ongoing breakouts on their skin. Whereas other patients might experience abscesses that leak a foul smelling pus one week, but then the following week the abscess will have cleared and the only remaining sign they were there will be a scar.

Doctors are not quite sure what causes Hidradenitis Suppurativa (HS), but there are individuals who are at higher risk of developing HS. For example, we know that women, African Americans, and people who have suffered with acne when they were younger are more susceptible to HS. We also know that it’s more common for HS to develop in patients who are in their early 20s.

There are many different treatment options for HS including antibiotics, acne washes, biologics, surgery, and even hormone therapy. The success rate with these treatment options varies from patient to patient, but because HS is a chronic condition non-surgical options only temporarily subside the symptoms.

Surgery can offer a more permanent relief and has a 90% cure rate with no reoccurrences, but patients require a comprehensive evaluation prior to considering this route. Deciding whether to operate will depend on the status of the affected areas. For example, if a patient has an acute infection, the first step will be to clear the infection with antibiotics. After the infection clears a wide surgical excision of the infected area is performed, followed up with reconstructive plastic surgery.

A board certified dermatologist who has extensive knowledge on HS may be a good option for patients who wish to control their HS with medication, but patients should consider a board certified plastic surgeon if they are seeking surgery because a plastic surgeon will have more knowledge and experience with the reconstructive aspect of the surgery.

If you or a loved one has been diagnosed with HS, the plastic surgeons at North Shore Center for Plastic Surgery can help you evaluate the extent of the disease and review the reconstructive options available during your consultation.

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