The most common places for hidradenitis suppurativa (HS) to manifest are the underarms, groin, upper thighs, buttocks, and — on women — the breasts. However, there are other, less common places where skin lesions can appear. Atypical sites for HS include the jaw, the legs, and the face.
More than 1,000 myHSteam members have reported lesions on the face as a symptom of HS. “I get them on my face, but they don't come to a head,” a member said. Another reported, “I get them on my face as well. I will not get them drained however, it is a pride thing.”
Members have described a variety of ways HS manifested on their faces:
While HS on the face is less common than in other places on the skin, the symptoms are similar. Here are some common symptoms:
Because it is so visible, myHSteam members reported more distress with HS on the face than other places. Describing facial lesions, one member said, “I get paranoid I'm going to end up with a huge one again that requires surgery to deal with and it terrifies me.” Another talked about facial pain. “I also have had a huge flare-up within the past two weeks. … Has included my face, my chest, and the original site inside my right breast. … I’m tired of being in pain or sick all the time.”
In most cases of HS, lesions only occur in parts of the body containing apocrine glands — the underarms, buttocks, breasts, and near the genitals. It is considered atypical for HS to occur in locations without apocrine glands, such as the face and eyelids. It is possible but uncommon to develop HS on the face; facial symptoms may also be caused by a separate skin condition.
Several other skin conditions can cause symptoms similar to HS, including acne vulgaris and folliculitis. To determine which condition is causing your facial symptoms, you need to consult a dermatologist with experience in diagnosing hidradenitis suppurativa.
Many treatment options for HS on the face are identical to treatments for HS lesions on other parts of the body. In some cases, different medications may be recommended due to the specific location of lesions.
Antibiotics can be used to treat infection of tracts or lumps, or used in a lower dosage to treat inflammation. One myHSteam member said, “My GP has put me on Doxycycline for three months. I’ve not had a flare-up since.” Antibiotics are usually given as oral medication, but an antibiotic cream made from Erythromycin can also be prescribed. “I have two topical creams to use that do help a lot,” another member said.
Anti-acne washes and facial scrubs cannot take away the cause of hidradenitis suppurativa, but they can be used to reduce facial bacteria and clogging in hair follicles.
Immunologics and immunosuppressant drugs, such as corticosteroids, are used to reduce inflammation in HS. However, doctors may prescribe only lower-potency corticosteroids for the face to avoid side effects such as skin atrophy. Humira (Adalimumab), which neutralizes tumor necrosis factor alpha, is given as an injection. Humira works by blocking cytokines present in immune system dysfunctions. “I am now trying Humira. It seems to be helping with my boils on the face, but I still have flare-ups in other places,” a myHSteam member said.
For some women, birth control pills help reduce HS symptoms. They work by suppressing the hormones that make breakouts less likely. “When I was taking the pill, my HS symptoms almost went away,” one member shared.
Finasteride, an androgen-reducing medication, has proven effective in certain cases. It also works on HS by altering hormones.
Retinoids such as Soriatane (Acitretin) are given in some cases. While they primarily work to treat acne, they can be used for HS as well. Retinoids are vitamin-A-derived medications. Since they are known to be extremely toxic to a developing fetus, women on the drug must use two different forms of birth control when taking them. (Small amounts of the drug have been found in the semen of men, but it’s not known whether it is enough to affect an embryo at conception.) Some types of retinoids, like Isotretinoin, do not appear to have much of an effect on HS.
Surgical treatments are typically only used when the above treatments have not been successful. Surgical procedures that can be done on the face include:
Members of myHSteam have reported a variety of treatment options for facial HS:
Have you experienced HS symptoms on the face? Do you have questions or tips to share? To start or join a conversation, comment below or on myHSteam.