Hidradenitis Suppurativa
Symptoms
Hidradenitis suppurativa (HS) causes painful, deep‑seated nodules, abscesses, and sinus tracts in intertriginous areas such as the axillae, groin, and under the breasts. Lesions often rupture and drain malodorous pus. Chronic inflammation leads to scarring and rope‑like bands. Flares can significantly impair quality of life. Severity ranges from isolated nodules to extensive interconnected tunnels.
Cause
HS originates from follicular occlusion and subsequent rupture, triggering an exaggerated immune response. Genetic predisposition, obesity, smoking, and mechanical friction increase risk. Hormonal influences explain onset after puberty and perimenstrual flares in women. Dysregulation of the innate immune system, with elevated TNF‑α and IL‑17, drives chronic inflammation. Bacterial colonization exacerbates secondary infection.
Treatment
Lifestyle changes—weight management, smoking cessation, and friction reduction—form the treatment foundation. Topical clindamycin or resorcinol help mild disease. Oral antibiotics, hormonal therapy, or biologics such as adalimumab, Cosentyx, or Bimzelx target moderate to severe HS. Surgical options include deroofing sinus tracts or wide excision. Pain control and psychosocial support are integral to management.
Dr. Beth Schulz-Butulis
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