Hidradenitis Suppurativa (HS)

HS is a chronic debilitating disease that affects millions of Americans. The disease starts as small acne-like bumps that can be found in body folds, such as the underarms, breasts, thighs, groin, and buttocks. HS progresses to form lesions that are deeper and more painful (abscesses), which may ooze pus. Eventually, these areas can form tunnels (also called sinus tracts) under the skin, which can leave behind scars. It is not clear whether all patients with HS will progress through each stage.

Listen to Dr. Paek speak on the “Dialogues in Dermatology” podcast about New and Emerging Therapies in HS (published June 2023):

Audio Recording

Transcript and Commentary

What causes HS?

While we do not know exactly what causes HS, the current understanding is that the hair follicles in certain areas of the body get blocked, and cause inflammation of the surrounding tissue. This leads eventually to the formation of abscesses and sinus tracts, and may even lead to bacterial infection of the involved follicles. Although bacteria (especially polymicrobial anaerobic bacteria) may be involved, HS is NOT a primary infection.

What are the different stages of HS?

There are three stages of HS under the Hurley classification: 

Stage I: mild- individual abscesses or nodules, without scarring or tract formation.

Stage II: moderate- individual scars and/or sinus tracts (interconnected lesions forming a tract under the skin, often with multiple openings), and with normal skin between nearby tracts.

Stage III: severe- diffuse involvement of HS and/or completely interconnected sinus tracts without normal skin between tracts. May also involve extensive scarring that can cause restriction in movement

What can I do to make my condition better?

All patients who have HS, regardless of their stage, can benefit from some simple lifestyle changes.

·       Smoking tobacco products has been linked to increase severity of HS, and quitting smoking has been shown to help with the resolution of the condition.

·       Weight loss helps to decrease the amount of friction and irritation within the folds of the body, and therefore also helps to calm down HS.

·       Wearing loose clothing also helps to decrease the irritation of HS lesions.

·       Diet may help some patients control their HS.

What can I expect?

At this time, HS is a difficult condition to treat with no known cure. All treatments are meant to relieve the pain, drainage and swelling of HS. Even more permanent treatment options, such as surgery, have known recurrent risks. However, this does not mean patients cannot achieve some sort of improvement. Every HS patient is an individual, and similarly, everyone responds differently. It may take several attempts to find the right combination of therapies to best suit your specific case, but in many instances we will be able to get your symptoms under control.

Where can I go for more information?

HS Foundation: www.hs-foundation.org

HS Support Group: https://hopeforhs.org/