Hidradenitis suppurativa (HS) is a chronic (long-term) condition characterized by painful, inflammatory nodules (boils, furuncles, abscesses, carbuncles) commonly affecting the axillae (underarms, under the breasts, inner thighs, buttocks, neck and groin). Flares are painful and often result in nodules bursting spontaneously resulting in drainage composed of blood-tinged pus.
Persistent lesions may lead to the formation of sinus tracts, or tunnels connecting the subcutaneous nodules. Healing of the nodules results in scar formation. Occasionally, severe flares result in contractures; this is especially true under the arms – resulting in decreased range of motion and mobility.
Who Gets Hidradenitis Suppurativa?
Hidradenitis suppurativa most commonly occurs in women between the ages of 20 and 29. An early age of onset may be associated with developing more widespread disease. Women are more likely to develop hidradenitis suppurativa. A tendency to develop hidradenitis suppurativa can be inherited. It can be associated with several other autoimmune conditions, arthritis, nodulocystic acne, obesity, inflammatory bowel disease, Crohn’s disease, metabolic syndrome and diabetes. Smoking tobacco has been linked to hidradenitis suppurativa.
Signs and Symptoms of Hidradenitis Suppurativa
- Inflammatory Nodules – These bumps often enlarge, break open and drain pus. These lesions are usually described as an abscess or boil. The drainage may have an odor. Itching and burning may accompany the bumps. The boils and abscesses usually appear in areas where skin rubs against skin, also known as redundant areas
- Hypertrophic Scars – Exaggerated or large scars over prior inflammatory nodules often are painful and occasionally itching.
- Sinus Tracts/Tunnels – Over time, tracts connecting the lumps may form under the skin. These wounds heal very slowly, if at all, and can leak pus.
- Small-pitted areas of skin containing blackheads – often appearing in pairs or a “double-barreled” pattern — are a common feature.
Effects of Hidradenitis Suppurativa
Hidradenitis Suppurativa affects far more than just the skin. The condition can have a severe and measurable affect on the quality of life. Affected patients with Hidradenitis Suppurativa may experience the following:
- Chronic Pain
- Sleep loss
- Loss of Mobility
- Short and Long Term Disability
- Emotional distress
Management and Treatment
The management and treatment of Hidradenitis Suppurativa is oftentimes complicated and requires a multidisciplinary approach. Dermatologists, surgeons, obstetricians, and radiation oncologists may all participate in the care of a patient with Hidradenitis Suppurativa. Strategies include:
- Maximizing personal hygiene, avoid tight fitting clothes, weight loss, smoking cessation
- Topical clindamycin, oral tetracyclines, oral clindamycin, oral rifampin and oral sulfa based antibiotics
- Hormonal Therapy. Estrogen based contraceptives, spironolactone.
- Biologic Therapy. Adalimumab, Infliximab.
- Intralesional steroids, oral steroids
- Surgical Therapy. Incision and drainage, excision, skin grafts.
- Radiation Therapy.
- Physical Therapy. To reduce contractures and mobilize hypertrophic scars
For participants, all investigational medication (or inactive placebo), study-related tests, and study doctor’s visits will be provided at no cost for the duration of the study, up to 37 weeks. Participation is voluntary and you may withdraw at any time.