Hidradenitis suppurativa (HS) is a chronic inflammatory condition in which painful nodules form under your skin. These lesions tend to occur in areas where skin touches skin, such as the armpits, groin area, buttocks, and breasts.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d8b99d7c-5dcd-409e-ae63-215f560bc9e8 Many people live for years with hidradenitis suppurativa before getting an accurate diagnosis, sometimes believing that they have acne (pimples). But HS is not acne, and it can get worse without proper treatment, so it’s essential to get a diagnosis as early as possible.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b646c1a9-147b-451b-bf34-0a0967b7ea44 To diagnose hidradenitis suppurativa, your doctor will evaluate the severity of the condition using the Hurley staging system. Here’s an overview of the stages of HS and what they mean for treatment.
Understanding the Hurley Staging System Hurley Staging The Hurley staging system consists of three stages of HS:e60dc2a1-f33c-4a05-9b50-8e3e8e597629b1632426-f3cc-486c-9e48-71f12afb1b2b Stage 1 (Mild) You have one or more abscesses, but no scarring or tunnels under the skin. Stage 2 (Moderate) You have one or more recurring abscesses that have caused scarring and tunnels under the skin. Stage 3 (Severe) You have recurring abscesses with scarring and tunnels covering or nearly covering an area, or interconnected abscesses or tunnels across the affected area. A number of factors have been linked to more severe HS, including having had the condition for a longer period of time, being male, and having a higher body mass index .e60dc2a1-f33c-4a05-9b50-8e3e8e597629ba42241b-9dfc-43fb-96c3-13908faaf781 In people whose hidradenitis suppurativa progresses beyond stage 1, it typically takes years to progress from one stage of to another. A survey of 225 people with HS found that those with stage 3 disease had a more aggressive disease course than was seen in people whose HS remained in stages 1 or 2 — so it’s important for everyone with the condition to get treatment as soon as possible, with the goal of preventing HS progression.e60dc2a1-f33c-4a05-9b50-8e3e8e597629dfbc178c-d2f3-4118-b464-542d63b74d90
Stage 1 Stage 1 In stage 1, one or more nodules or lesions appear under the skin, without scarring or tunnels (sinus tracts).e60dc2a1-f33c-4a05-9b50-8e3e8e59762901fdf8b2-3970-4be3-b228-6959b9ee39db These lesions may gradually heal and eventually go away. But in some people, they come back and can get worse over time — potentially progressing to stage 2.e60dc2a1-f33c-4a05-9b50-8e3e8e59762958fe974f-55be-4d36-8394-d658c88d961b In all stages of hidradenitis suppurativa, treatment should be individualized based on what type of lesions or sores you have, how painful they are, and how they interfere with your life. Your doctor may add or stop prescribing treatments over time, depending on how well they are working for you.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f40b52f6-069a-4b8d-8d6e-a798e39f608c Doctors typically treat people in stage 1 with topical ointments or creams, as well as hormone therapies. You may also be prescribed oral (taken by mouth) antibiotics at this stage. Treatments for stage 1 may include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629427a885f-2b4e-49fb-a783-6b4357e0c2f8 Clindamycin When used as a topical treatment, clindamycin can help reduce or shrink lesions, including those that contain pus. Resorcinol Applying a resorcinol cream has been shown to reduce inflammation and pain in HS, but it may take several months to help clear the affected area. Hormone Therapies Some hormone treatments are sex-specific, while others may be given to women or men. These therapies treat HS by counteracting other hormones that may contribute to inflammation. They may include estrogen , spironolactone, cyproterone acetate, metformin, or finasteride. Oral Antibiotics Taken orally once or twice a day, antibiotics may help reduce inflammation and bacteria that can cause HS flare-ups.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f40b52f6-069a-4b8d-8d6e-a798e39f608c Commonly prescribed oral antibiotics for HS include doxycycline, clindamycin, and rifampin. Oral Retinoids For some people with HS that resembles acne, drugs such as isotretinoin may be an option — but these drugs carry significant risks related to pregnancy. Steroid Injections To reduce swelling and inflammation, your doctor may inject a steroid such as triamcinolone into your HS sores.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295a3a81fa-6b9b-4e2c-ae4c-a876d3b715a7 At any stage of hidradenitis suppurativa, your doctor may recommend or prescribe topical hygiene or comfort measures such as using an antiseptic wash or applying a warm compress. Your doctor may also recommend surgery if other medications aren’t working and lesions and scarring persist. Types of surgical procedures include incision and drainage (cutting through the skin to the abscess to drain fluid), local excision (removing a small area of skin), laser hair removal, or using a specialized laser (known as a carbon dioxide laser) to destroy a lesion.e60dc2a1-f33c-4a05-9b50-8e3e8e597629427a885f-2b4e-49fb-a783-6b4357e0c2f8e60dc2a1-f33c-4a05-9b50-8e3e8e5976291c5db4cc-e9d9-45dd-96a0-ef004da2de26
Stage 2 Stage 2 In stage 2, one or more recurring nodules appear under the skin and lead to scarring or tunnels (sinus tracts).e60dc2a1-f33c-4a05-9b50-8e3e8e597629bd9bdedb-81d9-4e50-bf50-51e1cd723c01 HS sores that are connected by tunnels tend to heal slowly, if at all, and also drain blood and pus.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292ab6edc4-8ff3-4c65-b315-cf89a0db4a27 Treatments used in stage 1, such as steroids or hormone therapy, may be continued or started in stage 2, depending on the person’s individual needs. Treatments may be increased — for example, someone may start taking two different kinds of oral antibiotics.e60dc2a1-f33c-4a05-9b50-8e3e8e597629332b3aa8-fda7-479c-9f98-23f2355a21c9 Treatments for stage 2 include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629be3e11d3-0d6d-4a1f-8143-8b4d88b9d77a Biologic Drugs These injected or infused drugs work by altering your immune system’s response and can improve HS symptoms within a few weeks.e60dc2a1-f33c-4a05-9b50-8e3e8e59762932b860ff-b717-4de9-ac0b-975be300052d The following are approved to treat moderate-to-severe HS: Adalimumab (Humira)e60dc2a1-f33c-4a05-9b50-8e3e8e597629d2d291ac-47f9-4ff6-a2e0-ee15f1e6fe76 Secukinumab (Cosentyx)e60dc2a1-f33c-4a05-9b50-8e3e8e5976298e1dbd14-c119-4cd6-9f94-16c266c9ea70 Bimekizumab (Bimzelx)e60dc2a1-f33c-4a05-9b50-8e3e8e5976298794e0bc-379d-4432-899e-22d747172936 Infliximab (Remicade), which is not approved by the U.S. Food and Drug Administration but has been used in clinical trials and studiese60dc2a1-f33c-4a05-9b50-8e3e8e5976299be4fb32-bf22-4714-99b3-40743136bcda Intravenous (IV) Antibiotics Your doctor may give you the antibiotic ertapenem to reduce bacteria and inflammation. Other Treatments Your doctor may use injected steroids or surgical procedures, such as deroofing, to treat persistent HS lesions (just as in stage 1).e60dc2a1-f33c-4a05-9b50-8e3e8e597629be3e11d3-0d6d-4a1f-8143-8b4d88b9d77a
Stage 3 Stage 3 In stage 3, multiple interconnected lesions appear under the skin, covering or nearly covering an area (sinus tracts).e60dc2a1-f33c-4a05-9b50-8e3e8e597629d90c8178-819d-402b-a6aa-401752d854ce Just as in stage 2, these abscesses tend to drain blood and pus, but more so in this stage. The pain from HS sores in stage 3 can be debilitating.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291218fef0-5cef-4064-85fe-62da714bda4c Again, treatments used in stage 1 and stage 2 may be continued or started in stage 3. Biologic drugs and antibiotics, in particular, are often given in this stage. Treating HS in stage 3 can be challenging. If other treatments aren’t working, your doctor may recommend surgically removing an area of skin.e60dc2a1-f33c-4a05-9b50-8e3e8e59762968bfaa80-26e3-4863-873b-09b53bdba9d0 If a large enough area of skin is removed, you may need a skin graft to help close the wound. While surgical treatment tends to prevent HS sores from coming back in the affected area, you may still get sores in other areas of your body.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299765ee1d-970f-4499-84b2-e9fb0f7a3b04
When You Should See Your Healthcare Provider Doctor’s Visit If you notice any potential signs of hidradenitis suppurativa — including more subtle symptoms that could indicate a different health condition, such as acne — it’s a good idea to see a dermatologist as soon as possible. Do this if you experience any of the following issues in areas where skin touches skin (such as your armpits, groin area, buttocks, or breasts):e60dc2a1-f33c-4a05-9b50-8e3e8e59762957b3f076-6665-4fb2-9bda-64a2feca6c29 Blackheads Painful nodules Nodules or sores that leak fluid or pus It’s especially important to see a dermatologist if any of the following applies to your condition:e60dc2a1-f33c-4a05-9b50-8e3e8e59762957b3f076-6665-4fb2-9bda-64a2feca6c29 Painful Makes it difficult to move Doesn’t improve after a few weeks Returns within weeks of treatment Affects more than one location on your body Flares up often Your doctor will work with you to develop a treatment plan based on your symptoms and individual needs and desires.
Lifestyle Changes for Hidradenitis Suppurativa Lifestyle Changes At any stage of hidradenitis suppurativa, a number of lifestyle changes may help reduce your symptoms. Diet and Lifestyle Modifications Making certain changes to your diet, as well as your lifestyle more broadly, may help reduce HS symptoms. The following dietary changes may help:e60dc2a1-f33c-4a05-9b50-8e3e8e59762978bd6989-7a0a-4df7-83cd-1de37e267ae7e60dc2a1-f33c-4a05-9b50-8e3e8e597629c97d9342-ad9f-45ee-ba44-d034dff09890 Limit dairy products. Limit red meat. Avoid simple carbs like white rice, white pasta, juice, soda, and candy. Avoid alcohol, gluten, and yeast. Other lifestyle measures that might help:e60dc2a1-f33c-4a05-9b50-8e3e8e59762996f707f1-8af3-4939-9d70-f58021bdb8e3 Quit smoking. Lose excess body weight. Stay physically active, while taking care not to irritate your skin.e60dc2a1-f33c-4a05-9b50-8e3e8e59762978bd6989-7a0a-4df7-83cd-1de37e267ae7 Personal Care and Hygiene Keeping affected areas of your body clean, while taking care not to irritate them, can help reduce symptoms and improve your comfort. Consider taking these steps:e60dc2a1-f33c-4a05-9b50-8e3e8e597629e093699e-9353-470a-89f0-41141be47592 Use an antimicrobial wash. Don’t scrub your skin (wash gently). Be careful and gentle with shaving or waxing. Consider laser hair removal (as an alternative to waxing or shaving). Avoid sweating or getting too hot. Wear loose clothing that doesn’t rub against affected areas. Ask your doctor for recommendations about what kind of antimicrobial wash to use. Active ingredients in these products can include chlorhexidine or benzoyl peroxide. If you’re not using an antimicrobial wash, use a gentle soap-free cleanser.e60dc2a1-f33c-4a05-9b50-8e3e8e59762978bd6989-7a0a-4df7-83cd-1de37e267ae7 Coping With Symptoms For some people with HS, the pain and other symptoms can take a heavy emotional toll. Here are some steps that might help you cope with your condition:e60dc2a1-f33c-4a05-9b50-8e3e8e5976291c366e01-3aa5-499d-9f26-bb03cc537dcb Make sure you’re getting HS treatment that works. Ask about options for odor control if this concerns you. Join an HS support group (virtually or in person). Get screened and treated for depression. Psychotherapy (talk therapy) is an effective treatment for many people with depression related to their HS. Whether virtually or in person, seeing a counselor can help you cope.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291c366e01-3aa5-499d-9f26-bb03cc537dcb
Questions to Ask Your Doctor What stage of HS do I have, and what does this mean for treatment options? How can I prevent my HS from progressing to a later stage? Will my HS go away with treatment? Can my HS spread to other areas? How will my treatment change if my HS gets worse or stops responding to treatments?
The Takeaway Hidradenitis suppurativa can be diagnosed as stage 1 (mild), stage 2 (moderate), or stage 3 (severe), with different treatment options in each stage. See a dermatologist if you have any symptoms that could indicate HS, including what looks like acne or painful nodules in your armpits, groin area, buttocks, or breasts. Certain lifestyle changes may help reduce HS symptoms, including recommended hygiene practices, quitting smoking, and losing excess body weight.
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