The skin you're in
Hydradenitis suppurativa (HS) is a chronic skin condition, also called inverse acne, which affects one per cent of the population. More common in women than men, it can occur in people who've never had acne. HS tends to begin in teenage and young-adult years and affects the apocrine sweat glands of the armpit, groin and anal areas. It can also manifest where skin rubs together, e.g. between the thighs or under the breasts.
Signs & symptoms
Recurrent large (pea- to marble-sized) abscesses develop under the skin, which become inflamed and painful. They tend to rupture, draining pus. As the abscesses heal, they may create significant scarring. HS can be severe, causing a smell from the infections, which may lead sufferers to become isolated and depressed.
In most cases, the cause of HS is unknown, but is likely a combination of hormones, genetics and environmental factors. The sweat glands and hair follicles become blocked and tunnels form under the skin, linking the abscesses. Doctors know that poor hygiene is not the cause. Although obesity and smoking don't cause HS, they can worsen the condition.
Treatment & management
The first treatment is generally antibiotics, aiming to limit the disease in its early stages. Other medications that doctors may trial include:
- topical antibiotics, applied to the affected areas, along with benzoyl peroxide
- Metformin, a medication used for diabetes, which may reduce the severity of inflamed lumps
- a contraceptive pill which contains anti-androgenic progesterones
- diuretic medicines, to reduce the fluid
- oral retinoids, which are used to treat acne.
Surgical procedures may include lancing the painful lumps or injecting them with steroids. There are a range of surgical options which can be discussed with your GP or specialist.
The role of self-care is to improve comfort, minimise infection outbreaks and promote healing.
The following may be considered, in discussion with your treating doctor:
- taking zinc supplements, to lessen the frequency of outbreaks
- wearing loose- fitting clothes made from natural fibres
- losing weight, if excess weight is causing skin to rub together and increase perspiration
- applying warm compresses, to ease swelling
- applying ice packs, to reduce pain
- washing with an antibacterial solution
- eating a diet low in refined carbohydrates and anti-inflammatory foods
- avoiding hot, humid climates
- avoiding perfumed products, deodorants and shaving, which may aggravate affected areas.
HS was previously thought to be a rare condition, when only the worst cases were identified. Now, though, more patients are being diagnosed in the early stages, assisting treatment. However, the ongoing nature of the disease and treatment regimen can come at a personal cost.
Given the tender age at which HS often presents, patients may become self-conscious and anxious. Clinical psychologists can help with coping strategies and pain-support groups can provide social connections with other people with HS or similar conditions, as well as practical tips for day- to-day living.
Call Pain Link helpline 1300 340 357 or join APMA for Individual Pain Management Resources