Hidradenitis Suppurativa

Diagnosis

Hidradenitis suppurativa is often mistaken for acne or pimples, which can delay diagnosis for many people. A healthcare provider bases the diagnosis on your symptoms, the appearance of your skin, and your medical history. You may also be referred to a dermatologist, a specialist in skin conditions, since hidradenitis suppurativa can be complex and requires expert care.

Currently, there is no specific laboratory test to diagnose hidradenitis suppurativa. However, if pus or drainage is present, your healthcare provider may take a sample for laboratory testing to rule out infection or other skin conditions.

Early diagnosis is important because it can help prevent complications and improve treatment outcomes.

Treatment

Treatment for hidradenitis suppurativa may involve medicines, surgery, or a combination of both. The goal is to manage symptoms, reduce inflammation, and prevent new sores from developing. Your healthcare provider will help design a plan tailored to your condition. Regular follow-ups with a dermatologist are often recommended, and in severe cases, a multidisciplinary care team may be needed.

Medications
Different types of medicines can help control symptoms and prevent flare-ups:

• Antibiotics: Topical antibiotics may be used for mild symptoms, while oral antibiotics such as doxycycline, clindamycin, or rifampin are prescribed for more widespread disease. Severe cases may require long-term antibiotic use.

• Steroid injections: Triamcinolone acetonide injections can help reduce inflammation and swelling in active sores.

• Hormonal therapy: Hormonal medicines such as combined oral contraceptives or spironolactone can be effective for mild cases, particularly in women. Isotretinoin may also be used in certain situations.

• Biologics: Injectable medicines like adalimumab (Humira) and infliximab (Remicade) target the immune system and help reduce inflammation in moderate to severe cases.

• Retinoids: Oral retinoids may be helpful for acne-like symptoms but are not suitable during pregnancy or breastfeeding.

• Pain medicine: Over-the-counter pain relievers may be used for mild discomfort. For severe pain, prescription medication or referral to a pain clinic may be necessary.

Surgery or other procedures
Surgical treatments are often combined with medical therapy to manage the condition and prevent recurrence. The choice of procedure depends on the severity and extent of the disease.

Common surgical options include:

• Uncovering the tunnels (unroofing): Involves removing tissue to expose the tunnels beneath the skin. This procedure is usually effective for moderate to severe cases and often does not need to be repeated.

• Punch debridement: Also known as limited unroofing, this removes a single inflamed bump.

• Laser therapy: A carbon dioxide laser can remove affected tissue, and laser hair removal may help in the early stages of the condition.

• Surgical removal: In severe or persistent cases, all affected skin may be surgically removed, sometimes requiring a skin graft for closure.

• Incision and drainage: This method provides temporary relief but is no longer recommended as a long-term treatment since sores often return.

Effective treatment requires ongoing care and management. Working closely with your healthcare provider can help minimize flare-ups and improve quality of life.