The skin condition hidradenitis suppurativa (HS) is known for its painful, unattractive symptoms – like boils, blackheads, and sores – that can cause physical, psychological, and emotional burdens. But you don’t have to just live with them.
Many treatments and other resources are available to relieve symptoms and make life with HS easier. With help from a dermatologist, it’s possible to reduce symptoms and flares, get the disease under control, and improve how you feel about your condition.
You Can Get Treatment for HS Symptoms
Living with HS isn’t easy. It comes with physical and emotional challenges.
The first symptoms you may notice will show up on your skin. They can include:
Blackheads. You might find these in small, pitted areas of skin, for example in an acne scar. They tend to show up in pairs.
Small, painful lumps. You might first notice one under your skin that sticks around for weeks or months. Later, more may appear. They tend to crop up in places where you have a lot of sweat glands or where skin rubs together. You could see them in your armpits, groin, butt cheeks, and under your breasts.
Weeping, oozing bumps or sores. These boils or abscesses are bumps that fill with pus, get bigger, burst open, and drain. When it comes out, the pus usually smells bad.
Tunnels. These form under your skin and connect the lumps. They may look like scars or thick discolorations. They may heal slowly and drain blood and pus. They may not heal at all without treatment.
HS that goes on for a long time or is more severe can also cause:
- Infections in affected areas
- Scars or permanent skin changes
- A hard time moving, due to skin tightness around scars or pain
- Lymphedema, a swelling in your arms, legs, or genitals from pooling of a body fluid called lymph
- Anxiety, depression, and isolation due to embarrassment about your sores, odor, and appearance
- Long-term pain
These symptoms can be especially burdensome in Black people, who get HS at higher rates than others and seem to have more severe disease and symptoms.
Treatment for Physical Symptoms
The sooner you get treatment, and the more effective it is, the better you’ll do. With good and early treatment, you may be able to avoid the more serious long-term effects of HS and live well with the condition.
There’s no cure for HS, but a dermatologist will create a plan to get the disease under control and ease your symptoms. Treatment can:
- Cut down on flare-ups
- Heal open wounds
- Relieve pain
- Keep the disease from getting worse
Your treatment plan might include self-care, medicines, and procedures. Here’s what to know about each.
Self-care. Your plan could include cutting out soaps and other products that irritate your skin. You might use a benzoyl peroxide-based wash instead of soap. You may need to switch to a gentle antiperspirant.
Because HS can cause wounds that are very slow to heal or don’t heal at all, you’ll probably need to learn about wound care. Your doctor will show you how to keep wounds clean. You might have to change dressings several times a day.
Your self-care routine might also include pain management. Your doctor may recommend ice packs or lidocaine. If they aren’t enough, you might take over-the-counter or prescription pain meds. Some people benefit from alternative solutions, such as acupuncture and medical marijuana.
Medicine. Doctors can prescribe topical and systemic drugs for HS. You put topicals on your skin directly on the affected area. Systemic meds come in the form of shots or pills and work throughout your whole body.
You might take one or more of these topicals:
- Antibiotics to reduce inflammation and the pus it causes
- Resorcinol, a peel that reduces inflammation and the symptoms it brings by unclogging your pores
If topicals don’t do the trick, your dermatologist might want to try medicines that affect your whole body.
Adalimumab and secukinumab are the only systemic medicines approved by the FDA to treat HS. You inject them right under your skin. They’re a type of drug called a biologic. They work with your immune system to calm down the system-wide inflammation causing your skin flares.
Doctors might also recommend medicines approved for other purposes but that help with HS. They include:
- Antibiotic pills to cut inflammation and reduce skin symptoms
- Retinoid pills to cut inflammation and promote new skin cell growth
- Hormone pills such as birth control, to counteract any hormone problems that might play a role in HS
- Metformin, a diabetes drug that significantly cuts inflammation
Procedures. Dermatologists use several procedures to treat the skin symptoms and pain that HS can cause. You might get:
- Corticosteroid shots directly into a new bump to help ease pain and inflammation
- Laser hair removal every 4 to 6 weeks to reduce the number of sores on your skin
- Botox shots to keep you from sweating as much, which can cut down on infections
- Incision and drainage to open and drain a painful, pus-filled bump for relief that happens right away but is temporary
- Deroofing to remove the top layer of skin over a boil or abscess and leave it open to heal naturally, lowering the odds that it comes back
- Wide excision, where the doctor cuts away an entire lesion or tunnel. This is a lot like getting a mole removed. As with deroofing, the wound is left open.
- Laser surgery to remove affected areas of skin layer by layer
Treatment for Emotional Symptoms
For some people, HS-related skin lesions cause embarrassment and shame. You might not want to go out in public or see friends. But isolation isn’t good for your health, and it can lead to depression and anxiety.
When you get your physical symptoms under control, you could find that your mood is a lot better as well. But if your HS has made you depressed, there’s help for that, too. Tell your doctor how you’ve been feeling. They might recommend talk therapy, medicine, or both.
Support groups can help, too. Many people benefit from talking and listening to other people in the same boat. You can find groups that meet in person, online, and via social media. An in-person support group can be a way to socialize without feeling shame about the way your skin looks.
Check out these organizations that can connect you with support groups and other helpful resources:
- HS Foundation
- Hope for HS
- HS Connect
When you get treatment for the mood-related symptoms of HS, you might be better able to take care of and cope with the physical symptoms.
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
Mayo Clinic: “Hidradenitis Suppurativa.”
JAAD International: “Hidradenitis suppurativa in patients of color is associated with increased disease severity and healthcare utilization: A retrospective analysis of 2 U.S. cohorts.”
American Academy of Dermatology Association: “Hidradenitis Suppurativa: Diagnosis & Treatment.”
HS Disease: “Treatment – Antibiotics.”
My HS Team: “Birth Control Pills for HS: What To Know.”
