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Hidradenitis Suppurativa (HS), also known as acne inversa, is a chronic skin condition affecting many individuals globally. According to the Mayo Clinic, women are three times more likely to develop HS, and Black people are more likely to develop HS than people of other races. Despite its significant impact on those living with the condition, HS continues to be poorly understood. We believe it is time to reduce the stigmatization surrounding the condition and provide a safe space for you to learn more.
What Is Hidradenitis Suppurativa?
Hidradenitis Suppurativa (HS) is a condition that occurs when painful lumps and bumps begin to form under the skin, according to the Mayo Clinic. When HS appears, it typically flares in places where skin rubs together. Common areas, including the armpits, groin, breasts, and buttocks, often occur where hair follicles become blocked and inflamed.
The flares are compounded when the bumps or abscesses burst and blood and pus leak. HS bumps may heal slowly and become recurring. As a result, those with the condition could experience scarring. When the abscesses recur in the same area, the scarring may progress to tunneling when the sinus track beneath the skin is filled with pus.
We spoke with Dr. Kenyatta Mireku, a board-certified dermatologist, who provided insight on HS and common misconceptions.
BHM: What do dermatologists look for to reach an HS diagnosis?
Dr. Mireku: We look for recurrent painful lesions such as nodules, abscesses, and tunnels in intertriginous (skin folds) and creased areas such as the axillae (underarm), buttocks, breasts, and groin.
BHM: How do dermatologists classify HS regarding its severity?
Dr. Mireku: We use something called the Hurley stages:
- Stage 1 – solitary or multiple, isolated abscess formation without scarring or sinus tracts.
- Stage 2 – recurrent abscesses, single or multiple widely separated lesions, with sinus tract formation
- Stage 3 – diffuse or broad involvement, with multiple interconnected sinus tracts and abscesses.
BHM: Are there any things that specifically contribute to people developing HS?
Dr. Mireku: Yes, HS is more commonly seen and more challenging to treat in those who are overweight and those who smoke. HS is also more commonly seen in those with a history of inflammatory disorders such as cystic acne and pilonidal cysts and those with scalp disorder, dissecting cellulitis.
In addition, there is likely a genetic predisposition as approximately 40% of patients with HS report a family history of the disease in a first-degree relative.
BHM: Do you have any thoughts regarding why Black people are more prone to HS diagnoses?
Dr. Mireku: Honestly, the exact reason isn’t entirely clear yet. For sure, research has shown that there are higher rates of autoimmune disease and obesity, which are two known associations of HS, in black patients. These may be contributors; HS also seems to have a genetic predisposition.
BHM: How can we promote more healthy conversations about HS?
Dr. Mireku: I think awareness is critical. Many patients are either embarrassed or believe that they have a hygiene issue. Because of this, I feel that the incidence of HS is under-reported. Many people live with it for years before being diagnosed.
Patients need to understand that they have done nothing wrong, are not contagious, and have nothing wrong with their personal hygiene.
Additionally, they shouldn’t feel alone. There are things we can do to help.
Treatment Options
The HS Foundation has provided information about a few approaches for treating HS, including:
- Topical medicines, such as washes and medicines, are applied to the skin’s surface.
- Systemic medicines and pills can help reduce inflammation, reduce bacteria, and boost the immune system.
- Procedures, depending on the severity of one’s HS, laser treatments, lancing, minor surgeries, and more extensive surgeries can be beneficial for reducing inflammation and restructuring the skin.
- Complementary and alternative medicine (CAM) targets one’s diet, nutrition, and supplements and promotes mind and body techniques.
Treating HS looks different for everyone, and for many, a combination of treatments will be used, and specialists may be involved as well. Those living with an HS diagnosis or those who think they may have HS should visit their healthcare providers.
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