What Is the Best Treatment for Hidradenitis Suppurativa?

Hidrahenitis suppurativa is condition that causes pus-filled boils on the forearms. Hidrahenitis suppurativa is treated with oral and topical antibiotics, compresses, laser therapy and surgery.

If you repeatedly have painful bumps in your armpits or groin, you might have hidradenitis suppurativa. This is a common condition in which you repeatedly get pus-filled throbbing boils in your forearms. The condition is often recurring and embarrassing for youth.

The following tips may help prevent the boils from recurring

• Wear loose clothing.
• Stop smoking.
• Maintain good hygiene.
• Lose excess weight (if you are obese).
• Avoid underarm waxing. You may opt to shave the hair instead.

The doctor may prescribe/suggest

• Apply warm normal saline compresses and topical Burow's solution (5% aluminum subacetate) for 30 minutes to relieve pain (during the active inflammatory stage).
• Take a suitable antibiotic course.
• Topical antibiotics such as 1 percent clindamycin, along with povidone-iodine or 5% benzoyl peroxide, for frequent washing.
• For children,
  • Use topical 15 to 20 percent azelaic acid twice daily.
  • Take oral erythromycin or isotretinoin (0.7 to 1 mg/kg) for lump reduction and to stop recurrence.
• Surgical excision (in later stages and recalcitrant cases) or 
  • Use cryotherapy (an extremely cold liquid or an instrument used to destroy abnormal tissues).
  • Have carbon dioxide laser excision (10 to 15 W) followed by skin grafting.
  • Use smoothe diode beam laser (450 nm) or pulsed-dye laser.

Hidradenitis suppurativa is a chronic skin condition that may cause small, painful lumps under your skin. The lumps can break open or form tunnels under the skin. The condition mostly affects areas where the skin or skin folds rub together, such as the armpits, buttocks and groin.

Around one to four percent of people in their early 20s are affected by this condition and women are affected more than men.

The characteristic symptoms of these skin conditions are as follows

• Blackheads: It starts with small pitted areas of the skin containing blackheads. It may appear in several body locations such as the groin, pubic region, buttocks, armpits and under the breast and may return often.
• Painful lumps: It always starts with a single, painful small lump under the skin that persists for weeks or months. Later, you may have more bumps. They usually appear in body areas with hair follicles that are more prone to sweating such as the groin and armpits. It may also appear in areas where the skin rubs together, such as skin folds under the breast, buttocks and inner thighs.
• Tunnels: Over time, tunnels connecting the two lumps may form under the skin. They don’t improve in a few weeks, but heal very slowly and often flare. They can leak very smelly pus.

Some may experience only mild symptoms. The severity of this skin condition will be assessed by your doctor in three stages

• Stage I: Solitary or multiple isolated abscess (pus-filled lump/nodules) without the formation of any tunnel or scarring.
• Stage II: Recurrence of pus-filled lump, single or multiple widely spaced lesions (tissue damage) with the formation of tunneling in the wound.
• Stage III: A wide and large spread of pus-filled lumps with multiple tunnels in the wound.

The exact cause of hidradenitis suppurativa is unknown. It may be associated with risk factors such as

• Smoking 
• Excess weight
• Stress
• Hormonal changes
• Heat or humidity
• Puberty
• Gender (more common in women than in men)
• Family history 
• Genetic predisposition to acne
• Certain comorbidities such as
  • Inflammatory bowel disease (ongoing inflammation of the digestive tract)
  • Spondyloarthropathies (arthritis that usually strikes the bones in your spine and nearby joints)
  • Epithelial tumors (enlargement of cells that cover the outer layer of the ovary)
  • Pyoderma gangrenosum (a painful inflammatory skin condition)