Do you also have painful boils that often appear in your armpits and groin? (Hidradenitis Suppurativa)

Sometimes we get really big, painful bumps on sweaty areas like our armpits, groin, and under our breasts, right? Just as one is about to heal, another one pops up. Sometimes these bumps ooze pus and can even smell bad. While many people think of them as just a regular pimple or a sweat blister, they can actually be a different, long-term skin condition. Today we’re talking about a condition called Hidradenitis Suppurativa (HS) in medical terms. Although it sounds a bit complicated, let’s break it down into simple terms.

What exactly is Hidradenitis Suppurativa (HS)?

Simply put, HS is a long-term skin condition that causes recurring, painful bumps, lumps, and boils in areas of our skin where sweat glands are abundant. Some people also call it 'acne inversa'.

This is not like a regular pimple. HS is caused by a malfunction in our body's own immune system. To be precise, it is an autoinflammatory disease of the hair follicles . What happens is that our body's own defense system attacks our own hair follicles for no reason. This causes them to become swollen, red, and painful bumps. Over time, these can develop into pus-filled abscesses and sinus tracts under the skin.

What types of skin bumps occur in HS?

There are three main types of skin changes seen in HS. You may have one or more of these.

Who is most likely to develop HS? What are the risk factors?

Although anyone can develop this disease, some people are more likely to develop it.

• For women: Women are more likely to develop HS than men.
• Family history: If your mother, father, or a close relative has this condition, you are at a higher risk of developing it too.
• Hormonal changes: Changes in hormone levels (especially estrogen and androgens ) that occur after puberty and around menopause can contribute to this. For some women, symptoms worsen before their monthly period.
• Smoking: People who smoke are at a much higher risk of developing HS.
• Obesity: Weight gain is also a major factor affecting this.
• Hirsutism: People with conditions that cause excessive body hair growth are also at increased risk.

Where do HS tumors most commonly occur?

These tumors usually appear in areas where the skin rubs together, sweats, and stays warm and moist.

• Armpit
• Groin area
• Under the breast
• In the area of ​​the buttocks and anus
• Inner thigh
• Back of the neck
• Around the waist

Are these a sexually transmitted disease (STD)?

No. Absolutely not. HS is not a sexually transmitted infection (STI) . It is not even a contagious disease. So don't be unnecessarily scared about it.

Complications that can occur if HS is not treated properly

If HS is left untreated for a long time, some complications can develop. These don't happen to everyone, but it's important to be aware.

• Scars: After the boils heal, hard, deep scars may form in those areas.
• Infections: Bacteria can enter through open wounds and cause serious skin infections (cellulitis) .
• Damage to the lymphatic system: Long-term swelling can damage the lymphatic system, causing swelling in an arm or leg.
• Fistula: Very rarely, tunnels (sinus tracts) that form under the skin can connect to internal organs such as the intestines or bladder.
• Anemia: Long-term inflammation can cause anemia.
• Psychological effects: Constant pain, pus-filled cysts, and scarring can cause mental stress, anxiety, or depression .
• Skin cancer: This is very rare, but there is a very small risk of developing a type of skin cancer from long-term, non-healing wounds.

Who should I consult for HS condition?

If you have these symptoms, the best thing to do is to see a dermatologist . Sometimes, general practitioners can mistake this for a simple tumor or infection. But a dermatologist can accurately diagnose these symptoms and prescribe the most appropriate treatment for you.

The doctor will diagnose the condition by listening to your symptoms and examining your skin. This usually does not require any other tests.

What are the treatments for HS?

There is no cure for HS yet. However, there are many effective treatments to control symptoms, prevent new lesions, and minimize scarring. Treatment depends on the severity of your condition.

1. Skin Care

• Antiseptic wash: The doctor recommends special soaps to clean the areas with boils daily.
• Antiperspirants: You can use fragrance-free products that are suitable for sensitive skin.
• Retinoids: These creams contain vitamin A and reduce inflammation and promote skin cell renewal.

2. Pain control

• Cold or hot compresses: Applying an ice pack or hot water bottle can help relieve pain and swelling.
• Pain-relieving ointments: Creams containing local anesthetics such as Lidocaine can temporarily reduce pain.
• Painkillers: You can take regular painkillers or stronger medications if necessary, as prescribed by your doctor.

3. Medicines prescribed by the doctor

• Antibiotics: Antibiotics are not given to treat an infection. They are given to control the inflammation that occurs in HS. Sometimes, a low dose may be prescribed for several months.
• Biologic therapy: Drugs such as (Adalimumab) control the activity of the immune system and reduce inflammation.
• Metformin: This diabetes medication can also provide some relief from HS by controlling hormone levels and insulin resistance.
• Birth control pills: These help control women's hormonal imbalances and prevent symptoms from worsening before menstruation.

4. Treatment and procedures when the disease worsens

If symptoms are severe or don't respond to other treatments, your doctor may recommend things like:

• Steroid injections: Steroids can be injected directly into a painful tumor to quickly reduce swelling and pain.
• Incision and drainage: If there are large abscesses, a small incision is made to drain the pus and provide relief.
• Laser treatments: Lasers can be used to remove hair follicles or tumors.
• Surgery: Sometimes, complete surgical removal (deroofing or excision) of the sinus tracts and damaged skin is necessary.
• Botox® injections: This treatment can be used to control excessive sweating.

Things we can do to prevent HS from recurring

While we can't control some risk factors (like family history), there are some things we can do to prevent symptoms from worsening and complications.

• Avoid smoking: If you smoke, the best thing you can do is to quit. Ask your doctor for help with this.
• Control your weight: Losing weight reduces skin sagging and helps control hormone levels, which can have a major impact on reducing symptoms.
• Wear loose clothing: Wear clothes that are not tight, made of materials like cotton that allow your skin to breathe.
• Control sweating: Avoid hot and humid places as much as possible. If you sweat, clean up quickly.
• Avoid fragrances: Avoid scented soaps, deodorants, and skin creams. These can make the skin more sensitive.

Living with this condition can be emotionally challenging at times. Don't dwell on the pain, discomfort, and appearance. You are not alone. Talk about your feelings with someone you trust or your doctor. If necessary, you can also seek the help of a mental health counselor.