By Emily Reynolds, Dermatology Nurse Practitioner

Do you get recurrent painful “boils” or “abscesses” in the armpits, groin, buttocks or other skin folds?

These are embarrassing areas to bring up with your medical provider and often go undiagnosed or untreated. I encourage you to avoid suffering in silence. You may have a condition called Hidradenitis Suppurativa (hi-drad-uh-NIE-tis sup-yoo-ruh-TIE-vuh) or HS. We treat this condition frequently and want to help our patients manage the condition and feel comfortable with their skin.

What is Hidradenitis Suppurativa?

Hidradenitis Suppurativa (HS) is a skin condition that occurs in the groin, armpits, breasts, and abdominal skin folds in which inflamed reddish bumps occur and are often called “boils.” The lesions are recurrent and are extremely painful, appear suddenly, eventually open up and drain. Both men and women can be affected but are more commonly seen in women. It is often hereditary.

This condition develops due to blockage of the sweat gland ducts or hair follicles due to pores that are too small. When the pore becomes blocked, the hair follicle swells and eventually explode sideways underneath the skin causing what is called a “sinus tract”. This causes the development of large, red, hot, painful lesions that eventually break down and drain material that looks like pus. However, it’s not an infection but rather the drainage is material from the oil glands. Bacterial infection sometimes can occur as a secondary event.

What triggers Hidradenitis Suppurativa?

Hidradenitis Suppurativa is typically a genetic condition but can be influenced by hormones. It often starts around puberty and can worsen with the menstrual cycle. Smoking is a known trigger. There is also some evidence that dairy products and high glycemic diets (diets high in white, sugary carbohydrates) can worsen the condition. Stress is also a likely trigger. Tight clothing or anything that causes friction in the areas of the lesions may cause the pores to become more easily clogged. It is NOT caused by poor hygiene. It is NOT caused by being overweight but increased friction from extra weight may contribute to lesions becoming inflamed.

How is it treated?

It is important to note that no single treatment can “cure” HS. People with HS often require both lifestyle changes and medicines to help manage their condition.

What I recommend to my patients:  

• Avoid smoking.
• Reduce dairy and high sugar content in the diet (follow a dairy free and low glycemic index diet).
• Reduce friction in areas of susceptibility including the groin, underneath the breasts and armpits. Wear loose cotton clothing, boxer shorts or “boy shorts.”
• Avoid waxing or shaving the areas. Laser hair removal can be an effective hair removal treatment that can help reduce HS in hair bearing areas.
• Antiseptic washes with triclosan such as Dial or alternatively a Hibiclens or Benzoyl Peroxide wash may be helpful.

Prescriptions and medical treatments that I often talk to my patients about:

• Topical antibiotics applied morning & night can help with inflammation.
• Medications that target hormonal triggers included birth control pills or an extra male hormone blocker pill called spironolactone.
• Oral antibiotics can be used for short periods of time for their anti-inflammatory properties.
• Oral zinc gluconate can be taken 50 mg orally twice a day with food; Vitamin C 500 mg taken with the zinc twice a day may help strengthen pores. Vitamin D can may also help if you are deficient.
• If a lesion is acutely painful and swollen, an injection of cortisone to assist in quickly taking the inflammation.
• For patients with severe HS that constantly recurs and is causing significant scarring, a biologic medication that reduces the body’s immune response, called Humira (adalimumab) can be a helpful treatment.
• Surgical treatment may be an option for severe cases as well.

For more information, I suggest visiting: www.hs-foundation.org.

We treat this condition often, so rest assured that you can address HS.

Emily Reynolds, FNP-BC, DCNP is a Dermatology Nurse Practitioner. Within the practice, she specializes in women’s health dermatology issues. She is part of Vanguard’s Colorado Springs Broadmoor dermatology office at Broadmoor and Woodland Park dermatology office.

Vanguard Skin Specialists began as a Colorado Springs dermatology practice and now has additional office in Canon City, Pueblo, and Woodland Park. Vanguard specializes in the diagnosis and treatment of skin cancer, and also offers general dermatology, plastic surgery, and aesthetic medicine.