Hidradenitis suppurativa (HS) is a chronic skin disease that causes small but painful lumps to form beneath the skin. It mainly affects areas where skin rubs together, making the armpits, breasts, buttocks, inner thighs, and groin prime targets.

In those who have HS, the skin condition usually has its first appearance after puberty. The symptoms of hidradenitis suppurativa can last for years and increase with age. HS is not life-threatening, but it can have a marked effect on one’s quality of life. It causes frequent pain and inhibits physical movement, and it can be a source of self-consciousness and social isolation for those who have it.

“HS is devastating to self-esteem,” a myHSteam member said. “It killed my sex life because I feel so disgusting.”

Is There a Cure for Hidradenitis Suppurativa?

There is currently no cure for hidradenitis suppurativa, but it can go into remission with the proper treatment. Early diagnosis and treatment can help manage HS and minimize its progression. HS treatments focus on preventing new lesions from developing, preventing the formation of tunneling under affected skin, reducing existing lesions and tunneling, and managing pain.

People’s experiences with HS vary. Some experience remission following treatment with prescription medications or surgery, or after making significant lifestyle changes, such as losing weight. However, no one approach works for everybody. Recurrence rates vary based on the location of the lesions and the person’s age.

What Causes Hidradenitis Suppurativa?

The cause of HS is unknown, but some dermatologists believe it might be genetic. It may also be due to hormonal changes or problems with the immune system. Doctors believe there are specific risk factors. These include:

• Family history — It is possible to inherit a tendency to develop HS.
• Friction — Some people with HS have said that friction from tight-fitting clothes has caused flare-ups.
• Gender — Women have been found to be more likely to develop HS than men.
• Smoking — Tobacco use has been linked to the condition’s development.
• Weight — Many studies show a relationship between being overweight and developing HS.

Watch as Dr. Hadar Lev-Tov discusses therapies that can help prevent new HS lesions from developing.

Remission in Hidradenitis Suppurativa

Remission in HS can be achieved in several ways. There are different medicines and minimally invasive surgical procedures that can help. There are also changes you can make to your lifestyle that can go a long way toward reducing or eliminating HS symptoms.

Antibiotics

HS sores in advanced stages may become infected, requiring antibiotics to treat them. Topical antibiotics work where applied and can help in mild cases. Oral antibiotics treat the entire body, making them more likely to be prescribed in moderate or severe cases. Antibiotics combined with the antiandrogen finasteride have been shown to facilitate remission.

Biologics

Biologics are genetically engineered antibodies (proteins used by the immune system to neutralize inflammation). They are administered either by intravenous infusion or injection. Like antibiotics, biologics can be used to bring advanced cases of HS under control.

Corticosteroids

Corticosteroids, such as prednisolone and prednisone, are used to bring about remission by reducing inflammation, preventing new lesions from forming, and healing existing ones. Long-term use is considered dangerous, so to avoid any major side effects, treatment is usually limited to short durations of injections to affected areas during major flare-ups.

Hormonal Birth Control

Some doctors believe sex hormones can trigger flare-ups, so hormonal contraceptives are sometimes prescribed to women with HS. They can reduce the amount of fluid emanating from lesions and help women who experience flare-ups during their menstrual cycles.

Laser and Light Therapy

Those with moderate to severe HS who have not responded to other treatments may respond to laser or light therapy. Some doctors believe HS originates in hair follicles, so using intense pulsed light or the neodymium-doped yttrium aluminum garnet laser used in hair removal is an available treatment option. In a clinical study with 61 HS patients treated with a carbon dioxide laser, only 1.1 percent of study participants experienced a recurrence of a lesion in the treated area during a 19 year follow-up period.

Punch Debridement

Punch debridement, also called “mini-unroofing,” involves removing individual HS lesions with a tool commonly used in biopsies, followed by the cleaning and dressing of the wound. It's minimally invasive, and many people with HS have found it effective in permanently eradicating individual lesions. However, it can cause scarring and carries the risk of infection.

Unroofing

Unroofing is used when HS has become advanced, and it’s also a treatment option for those with regularly recurring flare-ups in the same location. Physicians performing the procedure remove the flesh that covers the tunnels under the skin. Unroofing can be performed with a laser or with traditional surgical instruments, but it can leave significant scar tissue.

Weight Loss

Obesity is considered an aggravating factor in HS. People with a body mass index in the obese range tend to have more severe hidradenitis suppurativa symptoms than those with an overweight BMI or those at a healthy weight. A study in the Journal of the American Academy of Dermatology found that two obese people who had undergone bariatric surgery experienced remission of their HS symptoms.

Another study of people who had bariatric surgery found that weight loss of 15 percent or higher was associated with a 35 percent decrease in HS symptoms. There was also a significant reduction in the number of flare-up sites.

You Are Not Alone With HS

When you join myHSteam, you gain a community of more than 20,000 people who have or are caring for someone with hidradenitis suppurativa. Treatments and remission are frequent topics of conversation.

Have you found any treatments that put your HS symptoms into remission? Do you have any tips for dealing with stress around treatments? Comment below or start a conversation on myHSteam.