You’ve probably heard of acne, eczema, and even psoriasis, or know someone who has one of these skin conditions. Another skin condition—less talked about, but still very common—is called hidradenitis suppurativa (HS).
“HS is less well-known than other skin conditions because it can be challenging to diagnose, and sometimes patients are reluctant to tell their doctor that they’re suffering from its effects,” says Beth Israel Deaconess Medical Center (BIDMC) dermatologist Alexa Kimball, MD, MPH.
HS is a chronic inflammatory skin condition that usually appears after puberty as small, painful lumps under the skin. The lumps typically develop where skin rubs together, such as the armpits, groin, between the buttocks, or under breasts.
“Symptoms may start off looking like blackheads or tender bumps and boils,” Kimball says. “But these areas can harden or enlarge substantially, becoming more irritated as skin rubs against skin and can lead to significant scarring.”
Some patients with HS say the condition starts off looking like pimples, deep acne-like cysts, or in-grown hairs. “HS occurs around hair follicles with many oil and sweat glands, so it can easily be mistaken for something else,” Kimball says. “A single occurrence of symptoms isn’t enough to diagnose it—HS is recurring and long-lasting.”
Early diagnosis of HS is important to help manage symptoms and prevent complications. “What starts as a small lump could progress into a painful abscess that ruptures,” Kimball says. “These wounds heal very slowly, can persist and drain pus for many years, and can result in tracts of scars.”
Although antibiotics are sometimes prescribed to help calm inflammation, HS is not an infection and it is not contagious. “Many people often feel embarrassed or ashamed when dealing with the symptoms of HS, but this isn’t your fault,” Kimball says. “It isn’t caused by poor hygiene or cleansing practices. People with HS often have a different pattern of the skin’s natural bacteria and their body responds to it in an abnormal and destructive way.”
Two significant lifestyle changes may help patients manage their HS. “Researchers have found that patients who are overweight or smoke cigarettes often show improvement in HS symptoms and a better response to treatment when changing these behaviors,” Kimball says. “This doesn’t mean that excess weight or smoking cause HS, but it does mean that these behaviors can impact the condition’s severity.”
It’s important to speak with your doctor or dermatologist if you are experiencing the symptoms of HS. “This is a chronic disease that can impact your daily life,” Kimball says. “Do not hide it. Your health care team can help manage the symptoms, keep new areas from forming and prevent complications.”
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