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Hidradenitis suppurativa

Hidradenitis suppurativa (hi-drad-uh-NIE-tis sup-yoo-ruh-TIE-vuh) is a chronic skin condition that features pea-sized to marble-sized lumps under the skin. Also known as acne inversa, these deep-seated lumps typically develop where skin rubs together — such as the armpits, groin, between the buttocks and under the breasts.

The lumps associated with hidradenitis suppurativa are usually painful and may break open and drain foul-smelling pus. In many cases, tunnels connecting the lumps will form under the skin.

Hidradenitis suppurativa tends to start after puberty, persist for years and worsen over time. Early diagnosis and treatment of hidradenitis suppurativa can help manage the symptoms and prevent new lesions from developing.

Symptoms Causes Risk factors Complications

Hidradenitis suppurativa commonly occurs around hair follicles, where many oil and sweat glands are found, such as in the armpits, groin and anal area. It may also occur in areas where skin rubs together, such as the inner thighs, under the breasts or between the buttocks. Hidradenitis suppurativa can affect a single area or multiple areas of the body.

Signs and symptoms of hidradenitis suppurativa include:

  • Blackheads. Small pitted areas of skin containing blackheads — often appearing in pairs or a "double-barreled" pattern — are a common feature.
  • Red, tender bumps. These bumps, or lesions, often enlarge, break open and drain pus. The drainage may have an unpleasant odor. Itching, burning and excessive sweating may accompany the bumps.
  • Painful, pea-sized lumps. These hard lumps, which develop under the skin, may persist for years, enlarge and become inflamed.
  • Leaking bumps or sores. These open wounds heal very slowly, if at all, often leading to scarring and the development of tunnels under the skin.

Hidradenitis suppurativa often starts after puberty with a single, painful bump that persists for weeks or months. For some people, the disease progressively worsens and affects multiple areas of their body. Other people experience only mild symptoms. Excess weight, stress, hormonal changes, heat or excessive perspiration can worsen symptoms.

When to see a doctor

Mild cases of hidradenitis suppurativa may be treated with self-care measures. Consult your doctor if the condition:

  • Is painful
  • Doesn't improve in a few weeks
  • Returns within weeks of treatment
  • Appears in several locations
  • Recurs often

Hidradenitis suppurativa develops when hair follicles become blocked and inflamed. It's not known why this blockage occurs, but a number of factors — including hormones, genetics, cigarette smoking and excess weight — may all play a role.

Hidradenitis suppurativa affects at least 1 percent of the population. Factors that may increase your risk may include:

  • Age. Hidradenitis suppurativa most commonly occurs in young adults.
  • Your sex.Women are more likely to develop hidradenitis suppurativa than are men.
  • Family history. A tendency to develop hidradenitis suppurativa can be inherited.

Hidradenitis suppurativa often causes complications when the disease is persistent and severe. These complications include:

  • Scars and skin changes. Severe hidradenitis suppurativa may leave rope-like scars, pitted skin or patches of skin that are darker than normal.
  • Restricted movement. Open sores and scar tissue may cause limited or painful movement, especially when the disease affects the armpits or thighs.
  • Obstructed lymph drainage. The most common sites for hidradenitis suppurativa also contain many lymph nodes. Scar tissue can interfere with the lymph drainage system, which may result in swelling in the arms, legs or genitals.
  • Social isolation. The location, drainage and odor of the sores — singly or in combination — can cause embarrassment and reluctance to go out in public, leading to depression.
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