Hidradenitis Suppurativa (HS) – An Overview

Posted on August 22, 2019

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by painful, recurring bumps typically in the armpits, groin, buttocks, and underside of breasts.1 HS is sometimes referred to as acne inversa. There is no cure for HS.2

HS is not contagious or transmitted by sexual contact.3 HS is not caused by poor hygiene.3

What is hidradenitis suppurativa?
Hidradenitis suppurativa is a chronic skin condition that causes painful bumps to develop under the skin. Bumps can cover large areas of the body and tunnels (also called tracts) can form underneath the skin connecting bumps. HS can lead to scarring, and bumps can rupture and leak smelly pus.3,4 HS bumps are also called lumps, nodules, lesions, or boils.

HS develops in areas of the body that have apocrine sweat glands. The body has two types of sweat glands – eccrine and apocrine. Most of the body is covered in eccrine sweat glands. Eccrine sweat glands release sweat directly onto the surface of the skin. Apocrine sweat glands are found in areas of the body with a concentration of hair follicles. In contrast to eccrine glands, apocrine glands release sweat into the hair follicle.5,6

Apocrine sweat glands are found in the armpits, groin, and between the buttocks. Apocrine glands are also found inside the ears, on the nipples and areolas, and in the nostrils, but HS does not impact those regions of the body.7

HS can also occur in areas of the body where the skin rubs together, such as the inner thighs and underneath the breasts.1

HS can look similar to other skin conditions and is sometimes misdiagnosed as acne, boils, cysts, or folliculitis (inflamed hair follicles).8 Read more about how HS is diagnosed.

Learn more about symptoms of HS.

What causes hidradenitis suppurativa?
The exact causes of hidradenitis suppurativa aren’t well understood.6 There is evidence that HS symptoms are caused by the body’s immune system attacking its own tissues. However, the reason why the immune system malfunctions requires more research.8 Hormones, genetics, and environmental factors are thought to play a role in the development of HS.2,6

HS develops after the onset of puberty. Scientists hypothesize that the timing of onset is related to the body’s changing levels of sex hormones during puberty. Likely for the same reasons, HS rarely develops after menopause in women.6

HS is not at all contagious or infectious.3 HS is not caused by sexually transmitted infections or lack of bathing.3

Read more about causes and risk factors for HS.

The history of hidradenitis suppurativa
It is likely that hidradenitis suppurativa has existed throughout human history. However, its name, origin, medical classification, and how it develops has been up for debate among researchers for more than 100 years.9

French surgeon Alfred-Armand-Louis-Marie Velpeau first described hidradenitis suppurativa in the 1830s.10 Velpeau suggested that HS was caused by rubbing, irritation, and lack of cleanliness. In 1854, another French surgeon, Aristide Auguste Stanislas Verneuil, made the connection that HS originates within the sweat glands.10 HS was known as Verneuil’s disease for many years due to his writings.10 The condition gradually became known as hidradenitis suppurativa, a term derived from the ancient Greek words for water (hydos), gland (adeno), inflammation (-itis), and “to form pus” (suppurare).11 In the late 1800s, French dermatologist Pierre-Antoine-Ernest Bazin wrote his opinion that HS was a type of syphilis.9

German political philosopher Karl Marx (1818-1883) suffered from a debilitating skin disease. After examining descriptions of the symptoms in Marx’s writing, researchers believe the condition was actually hidradenitis suppurativa.12

In the early 1900s, German scientist Paul Schiefferdecker discovered the two types of sweat glands: eccrine and apocrine.13 Since HS affects only areas containing apocrine glands, it subsequently became known as apocrinitis.9

In 1989, American dermatologists Gerd Plewig and Albert Kligman recommended hidradenitis suppurativa instead be known as acne inversa.9 However, this term never gained wide use. Also in 1989, HJ Hurley published a system for staging HS by severity. Most physicians still use the Hurley system to describe the severity of HS cases from I (mild) through III (severe).3

In 1990, Dr. Carmen C.W. Yu published the results of her microscopic study of HS tissue and theorized that HS likely begins with follicular occlusion, or plugging of the apocrine sweat gland duct.14

In the 21st century, research has focused on abnormalities in the sweat glands and the immune system that may singly or together lead to the development of HS.15 This research is leading to new approaches to treating HS.

In 2015, Humira (Adalimumab) became the first medication approved by the U.S. Food and Drug Administration (FDA) to treat hidradenitis suppurativa.16 Many other medications are currently being tested in clinical trials for their effectiveness and safety in treating HS.

How common is hidradenitis suppurativa?
HS is not a rare condition. An estimated 1 to 4 percent of Americans, or 3.2 to 13 million people, live with hidradenitis suppurativa.17 The global prevalence is also estimated to be between 1 and 4 percent. The incidence of HS is similar to psoriasis. HS impacts more than three times as many women as men.18

Among people in the United States, African-American women age 40 and under have the greatest risk of developing HS compared with other ethnic and age groups.19 Globally, people of African, Hispanic, and European descent have a higher risk of developing HS compared to people of Asian descent.6

How does hidradenitis suppurativa progress?
HS symptoms often start with one painful bump that persists for a few weeks or months. In some cases, HS symptoms remain mild while in other cases, people develop more lesions that can become more severe. Some women with HS find their symptoms diminish after menopause.1 Early diagnosis and treatment can help prevent HS cases from progressing from mild to severe.20

The Hurley staging system is used to classify stages of hidradenitis suppurativa. HS is described as stage I (mild), stage II (moderate), and stage III (severe).3

Stage I cases of HS usually involves just one or isolated lesions.20 If a person progresses to stage II, they might develop recurring skin lesions with sinus tract formation (narrow openings underneath the skin) and scarring.20 If HS progresses to stage III, a person may experience recurring lesions across large areas of the body with sinus tract formation, extensive scarring, and foul-smelling pus.1,3,20

Only about four percent of HS cases are classified as stage III. The vast majority of cases of HS are classified as stage I (68 percent) and stage II (28 percent).21

How is hidradenitis suppurativa treated?
There are several treatment options that can manage symptoms, minimize disease progression, and sometimes produce long periods of remission. Mild and moderate HS can often be treated with topical or oral medications. Severe HS may require surgery.20 Read more about treatments for HS.

Resources

External Resources

Internal Resources


FAQ

Is hidradenitis suppurativa contagious?
No, HS is not contagious. If you have HS, you cannot spread it to anyone else. If you do not have HS, you cannot “catch” HS from someone with the condition.1

Do sexually transmitted infections cause hidradenitis suppurativa?
No. While HS symptoms often occur near the genitals and anus, they are unrelated to sexually transmitted infections. HS cannot be contracted or spread through sexual activity.3

Is hidradenitis suppurativa caused by poor hygiene?
No, there is no relationships between HS and lack of bathing or poor personal hygiene. HS is related to issues with the immune system, genetics, and hormones.1

Who treats hidradenitis suppurativa?
HS can be treated by primary care physicians and dermatologists. A primary care physician may refer you to a dermatologist for more specialized care. Surgical procedures for HS are usually performed by plastic surgeons.1


References

  1. Hidradenitis suppurativa: Symptoms & causes. (2019, May 16). Retrieved June 26, 2019, from https://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/symptoms-causes/syc-20352306
  2. Hidradenitis Suppurativa. (2012). Retrieved July 22, 2019, from https://rarediseases.org/rare-diseases/hidradenitis-suppurativa/
  3. Hidradenitis Suppurativa. (n.d.). Retrieved June 26, 2019, from https://www.hs-foundation.org/what-is-hs
  4. Hidradenitis Suppurativa Management and Treatment. (2018, February 23). Retrieved June 26, 2019, from https://my.clevelandclinic.org/health/diseases/17716-hidradenitis-suppurativa/management-and-treatment
  5. Sweat glands. (n.d.). Retrieved July 30, 2019, from https://www.mayoclinic.org/diseases-conditions/hyperhidrosis/multimedia/sweat-glands/img-20007980
  6. Harding, M. (2016, December 2). Hidradenitis Suppurativa: HS: Causes, Tests & Treatment. Retrieved July 26, 2019, from https://patient.info/skin-conditions/hidradenitis-suppurativa-leaflet
  7. NCI Dictionary of Cancer Terms. (n.d.). Retrieved July 26, 2019, from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/apocrine-gland
  8. Hidradenitis suppurativa. (n.d.). Retrieved June 26, 2019, from https://www.aad.org/public/diseases/painful-skin-joints/hidradenitis-suppurativa#causes
  9. Tilles, G. (2006). Verneuil and Verneuil’s Disease: An Historical Overview. In Hidradenitis Suppurativa (pp. 4-10). Springer. doi:10.1007/978-3-540-33101-8_2
  10. Jovanovic, M., MD. (2018, October 19). What is the historical understanding of hidradenitis suppurativa (HS)? Retrieved July 2, 2019, from https://www.medscape.com/answers/1073117-30764/what-is-the-historical-understanding-of-hidradenitis-suppurativa-hs
  11. Hidradenitis suppurativa. (n.d.). Retrieved July 26, 2019, from https://medical-dictionary.thefreedictionary.com/hidradenitis suppurativa
  12. Shuster, S. (2007). The nature and consequence of Karl Marx’s skin disease. British Journal of Dermatology. doi:10.1111/j.1365-2133.2007.08282.x
  13. Deodorants and Antiperspirants. (2019, March 17). Retrieved July 26, 2019, from https://cosmeticsandskin.com/fgf/deodorants.php
  14. C.‐W.YU, C. and COOK, M. (1990), Hidradenitis suppurativa: a disease of follicular epithelium, rather than apocrine glands. British Journal of Dermatology, 122: 763-769. doi:10.1111/j.1365-2133.1990.tb06264.x
  15. Zee, H. H., Laman, J. D., Boer, J., & Prens, E. P. (2012). Hidradenitis suppurativa: Viewpoint on clinical phenotyping, pathogenesis and novel treatments. Experimental Dermatology,21(10), 735-739. doi:10.1111/j.1600-0625.2012.01552.x
  16. Han, D. H. (2015, September 11). First Drug for Hidradenitis Suppurativa Approved. Retrieved July 26, 2019, from https://www.empr.com/home/news/first-drug-for-hidradenitis-suppurativa-approved/
  17. Mental & Emotional Health Support. (n.d.). Retrieved June 26, 2019, from https://www.hs-foundation.org/mental-emotional-health/
  18. Dufour, D. N., Emtestam, L., & Jemec, G. B. (2014). Hidradenitis suppurativa: A common and burdensome, yet under-recognised, inflammatory skin disease. Postgraduate Medical Journal,90(1062), 216-221. doi:10.1136/postgradmedj-2013-131994
  19. Armstrong, W. (2017, November 28). The Largest-Ever Epidemiological Study Brings Hidradenitis Suppurativa Into Sharp Focus. Retrieved July 26, 2019, from https://www.medpagetoday.com/resource-centers/advances-in-dermatology/largest-ever-epidemiological-study-brings-hidradenitis-suppurativa-into-sharp-focus/1641
  20. Lee, E. Y., Alhusayen, R., Lansang, P., Shear, N., & Yeung, J. (2017). What is hidradenitis suppurativa? Canadian Family Physician,63, 114-120.
  21. Zouboulis, C., Desai, N., Emtestam, L., Hunger, R., Ioannides, D., Juhász, I., … Jemec, G. (2015). European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. Journal of the European Academy of Dermatology and Venereology,29(4), 619-644. Doi:10.1111/jdv.12966
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