Hidradenitis Suppurativa (HS)

Hidradenitis suppurativa (HS) is a noncontagious, inflammatory skin disease. It occurs when clogged hair follicles produce painful lumps under the skin. 

Without treatment, these skin lumps keep coming back. As they grow in size and number, they can cause permanent skin damage and other complications.

There isn’t a cure for HS yet. But treatments available at Rush can significantly improve your symptoms and quality of life.

Hidradenitis Suppurativa Symptoms

Hidradenitis suppurativa lumps tend to form in skin folds, or areas where skin rubs against skin. This includes the armpits and inner thighs, under the breasts or buttocks, and in the genital area.  

You should see a dermatologist right away if you have painful lumps in the areas associated with HS, especially if these lumps: 

• Leak foul-smelling fluid
• Form in more than one part of the body
• Reappear or won’t go away, even after treatments prescribed (or performed) by other providers
• Seem to be getting worse or showing up more frequently

If your health insurance plan requires you to have a referral before seeing a dermatologist, start with your primary care provider. If you already have a referral, or you don’t need one, you can make an appointment with the dermatology team at RUSH.

Why Hidradenitis Suppurativa Requires Expert Dermatology Care

Symptoms of HS occur in cycles (flare-ups) that tend to follow a pattern:

• The skin lumps multiply and grow, burrowing deeper under the skin. 
• Some lumps break open. They may drain above the skin, leaving an open wound, or cause painful abscesses (pockets of pus) to form below the skin.
• Over time, “tunnels” (sinus tracts) connecting several abscesses may also form beneath the skin. If any of these tunnels run from an abscess to the skin’s surface, they’ll leak pus. And if bacteria gets into these abscesses, they may become infected.

Hidradenitis suppurativa abscesses may eventually heal on their own, but they can come back during a future flare-up. This continuous cycle of inflammation and healing also causes the skin to thicken and scar, which can restrict movement. 

Catching and treating HS early helps prevent or reduce flare-ups — improving painful or embarrassing symptoms as well as your confidence. 

However, because the lumps associated with HS look like large pimples or common boils, the condition is often misdiagnosed. Many people with HS don’t get the care they need until years after their symptoms appear. By this time, their symptoms may be severe (and harder to treat). 

Hidradenitis Suppurativa Care at RUSH

RUSH dermatologists have the experience it takes to diagnose HS and provide the most effective combination of treatments. 

Treatments often include medicine, laser procedures or surgery. The number and type of treatments you’ll need depends on whether your symptoms are mild, moderate or severe. And at RUSH, your personal preferences and goals are an equally important part of your treatment plan.

Medicine

Today there are more medications to improve HS symptoms than ever before — and they’re all available at RUSH. These medications come in several forms, including skin creams, pills and IV infusions. They include the following:

• Topical medicines: Creams or gels applied to the skin can help kill bacteria or reduce inflammation. They’re usually used when skin lumps or abscesses are small in size or number.
• Systemic antibiotics: Oral antibiotics help with skin problems that are more severe or widespread. You may need to take these for weeks or months.
• Hormonal therapies: Certain medications help block hormones that can increase inflammation.
• Steroids: Steroid pills or injections can help reduce pain and inflammation, especially during a flare-up.
• Retinoids: These vitamin A-based drugs can help control the inflammation associated with HS.
• Biologics: These medicines help break the cycle of inflammation by calming your immune system. 

Laser and Light Treatments

RUSH dermatologists offer several laser procedures that can help improve HS symptoms or prevent flare-ups. These include intense pulsed light (IPL) therapy, photodynamic therapy and Nd:YAG laser treatment. 

Certain laser treatments remove hair. Undergoing laser hair removal in the earliest stage of HS may prevent clogged hair follicles and later skin problems.

Other laser treatments help burn away tissue damaged by recurring abscesses and tunnels. The laser scars the remaining tissue, making it hard for abscesses to return. 

Surgery

Certain surgical procedures remove skin lumps or damaged tissue, or prevent the skin from scarring and tightening. RUSH offers the following:

• Deroofing: This office-based procedure is also known as unroofing. Your dermatologist removes the “roof” (layers of tissue) covering an abscess or tunnel, then cleans out the damaged area. The remaining wound is bandaged until it heals. Because this wound heals normally, there is less risk of developing scar tissue that limits movement.
• Local excision: Your dermatologist cuts out a single skin lump, or several skin lumps contained to a small area. This is usually an outpatient procedure.
• Wide excision: Your dermatologist removes a larger area of skin prone to recurring lumps and abscesses. Depending on the amount of tissue removed, you may need a skin graft to cover the wound.

Lifestyle Changes 

Certain factors, such as smoking and obesity, are linked to an increased risk of HS. When paired with medication or other treatments, the following lifestyle changes may help you reduce the severity of your symptoms or the frequency of your flare-ups: 

• Losing weight
• Quitting smoking
• Reducing (or learning to cope with) stress

If your dermatologist thinks you can improve your HS symptoms with lifestyle changes such as these — or you’d like to receive mental or emotional support — they can refer you to specialists who can help (or recommend services at RUSH or in the community).

RUSH Excellence in Hidradenitis Suppurativa Care

• Tailored, team-based treatments: People with HS are at risk for other health problems, including metabolic syndrome, joint pain, inflammatory bowel disease and depression. At Rush, you have access to a team of specialists who can treat any of the physical and emotional challenges associated with HS. These specialists range from general surgeons and pain management experts to rheumatologists and mental health professionals. They collaborate with your dermatologist to ensure you receive all the care and support you need to live life more fully.
• Chicago’s only dermatologist-led infusion center: RUSH offers a unique infusion center for people with skin disorders who need IV medicines. Because this center is led by RUSH dermatology providers with expertise in HS drugs, you’ll have immediate, on-site support should you experience any side effects. The infusion team also makes your experience more efficient. They’ll work with your health insurance provider to make sure your IV medicines are covered, and help you promptly schedule future visits. 
• Expert skin cancer care: Having HS can increase your risk of a type of skin cancer called squamous cell carcinoma. Your RUSH dermatologist will routinely screen you for skin cancer, so any suspicious skin changes are diagnosed quickly. And if you need skin cancer treatment, you can take comfort knowing our dermatologists partner with other clinical experts at the nationally renowned RUSH University Cancer Center. We provide advanced treatments such as immunotherapy and Mohs surgery, which has the highest cure rate of any skin cancer procedure.