Hidradenitis Suppurativa

Hidradenitis suppurativa is one of our specialties. Be sure to visit our dedicated Help for HS website!
What Is Hidradenitis Suppurativa?

Also known as acne inversa or Verneuil's disease, hidradenitis suppurativa (HS) is a chronic, autoinflammatory relapsing skin disease. It is characterized by painful bumps and boils located primarily in the armpits (axillae), groin, genitals, anal folds, buttocks, scalp, nape of neck and under the breasts. In some cases, HS can also be found in "atypical" areas such as the areola of the breast, around the navel, scalp, over the cheekbones, in front of the ear, behind the knees, and on the thighs. Any place on the body that contains terminal hair follicles could potentially develop HS lesions.

A person may have boils in one or several of these locations. Females tend to have more armpit lesions, while males tend to have more anal and genital lesions.

It is important to understand that HS is not the same as regular acne (acne vulgaris). Hidradenitis suppurativa affects approximately 1%-4% of the population, and the incidence is on the rise. Females are affected much more often than males, and it is thought to be more common in people of African descent.

Complications can be serious and include scarring, rectal or urethral fistulas, anemia, squamous cell carcinoma, meningitis and pneumonia.

What Causes Hidradenitis Suppurativa?

The exact cause of hidradenitis suppurativa is unknown and multifactorial, but it does involve genetic influences and defects in the innate immune system.

The disease process involves a buildup of keratin protein deep inside the hair follicle. The follicle becomes clogged, enlarged, and eventually ruptures, which then spreads to the nearby hair follicles. This creates a chronic inflammatory response and promotes abscess formation.

There are several known risk factors for developing hidradenitis suppurativa.

We tend to see this condition in people with metabolic imbalances such as high insulin, diabetes and obesity, as well as in smokers. High testosterone contributes to this condition by increasing hair thickness, slowing wound healing and increasing sebum (oil) production in the skin.

Oral contraceptives (birth control pills) can cause hidradenitis suppurativa in some women. Food allergies should be explored, especially allergies to brewer's yeast (Sacchromyces cerevisiae) and wheat, which are practically universal in patients with hidradenitis suppurativa.

There is a strong association with Crohn's disease and hidradenitis suppurativa. Nearly 40% of people with hidradenitis suppurativa also have Crohn's, and it has been theorized that Crohn's lesions around the anus may actually be hidradenitis suppurativa lesions.

Signs and Symptoms: How to Tell if You Might Have Hidradenitis Suppurativa

Most people with hidradenitis suppurativa notice the onset of symptoms between 11-30 years of age.

The earliest symptoms are usually pain, itching, burning, redness and increased sweating in the area.

Later, lesions appear as small, painful bumps and pustules that turn into deep, inflamed nodules and boils.

Over weeks or months, the lesions become progressively swollen. Eventually, the lesions may rupture and release foul-smelling pus and bloody fluid. This release is called suppuration. The process happens over and over, and may eventually lead to severe scarring and restricted movement. In the late stages of this condition, a person may have severe headaches, cramps and joint pain.

How is Hidradenitis Suppurativa Diagnosed?

Because most doctors are unaware of hidradenitis suppurativa, there is an average 12-year delay in diagnosis for many people.

If you think you might have hidradenitis suppurativa, it is important to seek an evaluation from a licensed healthcare practitioner so that you can rule out other conditions such as squamous cell cancer, breast cancer, lymphogranuloma inguinale, vegetating pyoderma, folliculitis, carbuncles, furuncles, erysipelas and Crohn's disease.

The diagnosis is based on the characteristic appearance of the lesions and your medical history.

There are no lab tests to diagnose hidradenitis suppurativa, but your blood work might show an elevated white blood cell count, high c-reactive protein, and an elevated erythrocyte sedimentation rate (ESR) if you have this condition.

What are the Conventional Treatment Options for Hidradenitis Suppurativa?

Conventional treatment for hidradenitis suppurativa includes antibiotics, over-the-counter painkillers, topical anesthetics, systemic retinoids (isotretinoin), steroid shots, immune-suppressing drugs (Humira®, Enbrel®), anti-androgen drugs and surgery.

One major problem with the standard treatment approach is that antibiotics will worsen the immune system imbalance that is fueling the autoinflammatory response in the first place. Immune-suppressing drugs have dangerous side-effects and may lead to serious infections, liver failure, cancer and lupus-like syndromes.

What are the Natural Treatments Options for Hidradenitis Suppurativa?

There are so many natural and effective treatment options for hidradenitis suppurativa!

At our clinic, we take a comprehensive approach including clinical nutrition, herbal medicine, digestive support and lifestyle modifications.

Having adequate levels of vitamin B12, vitamin A, vitamin D3 and zinc is essential. Maintaining healthy sleep and circadian cycles is equally important. There is no "one size fits all" approach, but the goal is to REMOVE the factors that are contributing to your condition (inflammatory foods, poor sleep, blood sugar imbalance, etc.) and ADD the support that will allow your body to heal.

We assess patients for food sensitivities, nutrient deficiencies, and also GI infections or overgrowths that may contribute to inflammation. We tend to check the insulin and blood sugar levels of all patients, and this is especially important for patients with hidradenitis suppurativa.