Hidradenitis suppurativa (HS) – NHS

Hidradenitis suppurativa (HS) is a painful, long-term skin condition that causes skin abscesses and scarring on the skin.

The exact cause of hidradenitis suppurativa is unknown, but it occurs near hair follicles where there are sweat glands, usually around the groin, bottom, breasts and armpits.

For reasons that are unknown, more women than men have the condition. It’s thought to affect about 1 in 100 people.

Symptoms

The symptoms of hidradenitis suppurativa range from mild to severe.

It causes a mixture of boil-like lumps, blackheads, cysts, scarring and channels in the skin that leak pus.

Hidradenitis suppurativa can cause fleshy lumps to grow on the surface of the skin

Credit:

GIRAND/BSIP/SCIENCE PHOTO LIBRARY https://www. sciencephoto.com/media/668613/view

Sometimes, narrow channels (sinus tracts) form under the skin, which can break out on the surface and leak pus

Credit:

Alamy Stock Photo https://www.alamy.com/stock-photo-hidradenitis-suppurativa-52484079.html?pv=1&stamp=2&imageid=B6F62B10-1A6C-45D2-B395-4D3CF16D45CE&p=17774&n=0&orientation=0&pn=1&searchtype=0&IsFromSearch=1&srch=foo%3dbar%26st%3d0%26pn%3d1%26ps%3d100%26sortby%3d2%26resultview%3dsortbyPopular%26npgs%3d0%26qt%3dD1ARYB%26qt_raw%3dD1ARYB%26lic%3d3%26mr%3d0%26pr%3d0%26ot%3d0%26creative%3d%26ag%3d0%26hc%3d0%26pc%3d%26blackwhite%3d%26cutout%3d%26tbar%3d1%26et%3d0x000000000000000000000%26vp%3d0%26loc%3d0%26imgt%3d0%26dtfr%3d%26dtto%3d%26size%3d0xFF%26archive%3d1%26groupid%3d%26pseudoid%3d%7bA883FDE5-7F3D-4472-81F5-B61111916852%7d%26a%3d%26cdid%3d%26cdsrt%3d%26name%3d%26qn%3d%26apalib%3d%26apalic%3d%26lightbox%3d%26gname%3d%26gtype%3d%26xstx%3d0%26simid%3d%26saveQry%3d%26editorial%3d1%26nu%3d%26t%3d%26edoptin%3d%26customgeoip%3d%26cap%3d1%26cbstore%3d1%26vd%3d0%26lb%3d%26fi%3d2%26edrf%3d0%26ispremium%3d1%26flip%3d0%26pl%3d

The condition tends to start with blackheads, spots filled with pus and firm pea-sized lumps that develop in one place. The lumps will either disappear or rupture and leak pus after a few hours or days.

New lumps will then often develop in an area nearby. If these are not controlled with medicine, larger lumps may develop and spread. Narrow channels called sinus tracts also form under the skin that break out on the surface and leak pus.

Hidradenitis suppurativa can be very painful. The lumps develop on the skin in the following areas:

• around the groin and genitals
• in the armpits
• on the bottom and around the anus
• below the breasts

The lumps may also appear on the nape of the neck, waistband and inner thighs.

Some of the lumps may become infected with bacteria, causing a secondary infection that will need to be treated with antibiotics.

Many people with hidradenitis suppurativa also develop a pilonidal sinus, which is a small hole or “tunnel” in the skin at the top of the buttocks, where they divide (the cleft).

What causes hidradenitis suppurativa?

The exact cause of hidradenitis suppurativa is unknown, but the lumps develop as a result of blocked hair follicles.

Smoking and obesity are both strongly associated with hidradenitis suppurativa, and if you’re obese and/or smoke it will make your symptoms worse.

Hidradenitis suppurativa usually starts around puberty, but it can occur at any age after puberty. This may suggest that sex hormones play a part. Many people with the condition also have acne and excessive hair growth (hirsutism).

In rare cases, hidradenitis suppurativa may be linked to Crohn’s disease, particularly if it develops around the groin area and the skin near the anus. Crohn’s disease is a long-term condition that causes the lining of the digestive system to become inflamed.

Hidradenitis suppurativa runs in families in about 1 in 3 cases. It’s not infectious and isn’t linked to poor hygiene.

Diagnosing hidradenitis suppurativa

There’s no definitive test to help diagnose hidradenitis suppurativa.

A GP will examine the affected areas of skin, and they may take a swab of an infected area. This can be helpful in making a diagnosis because the condition is not usually associated with the presence of bacteria that cause skin infections.

Hidradenitis suppurativa could be mistaken for acne or ingrown hairs.

Treating hidradenitis suppurativa

Hidradenitis suppurativa is a lifelong, recurring condition that is often difficult to manage, although the symptoms may improve or eventually stop with treatment.

It’s important to recognise and diagnose the condition in its early stages to prevent it getting worse.

In the early stages, it may be controlled with medicine. Surgery may be required in severe or persistent cases.

Antibiotics

If you have lumps that are particularly painful, inflamed and oozing pus, you may be prescribed a 1- or 2-week course of antibiotics, if test show that you have a bacterial infection.

If bacterial infection is not present, low doses of antibiotics may be used to prevent inflammation. This longer course of antibiotics will last at least 3 months, to reduce the number of lumps that develop.

You may be given antibiotics as a cream (topical) or as a tablet, capsule or liquid. Antibiotic types can include lymecycline, doxycycline, erythromycin or clarithromycin.

In severe cases of hidradenitis suppurativa, a combination of clindamycin and rifampicin can be effective.

Antiseptics

Antiseptic washes, such as 4% chlorhexidine, applied daily to affected areas are often prescribed alongside other treatments.

Retinoids

Retinoids, such as acitretin, are vitamin-A based medicines that help some people with hidradenitis suppurativa.

Retinoids are always prescribed by dermatologists. They must be used with caution and cannot be taken during pregnancy. It’s also important to avoid getting pregnant for 3 years after stopping treatment, so they’re not usually prescribed if there’s a chance you could get pregnant.

Contraceptives

If hidradenitis suppurativa flares up before a period you may benefit from taking oral contraceptives.

Immunosuppressive treatments (infliximab and adalimumab)

In severe cases of hidradenitis suppurativa, treatments that suppress the immune system, such as adalimumab or infliximab, can be useful.

However, there are risks associated with suppressing the immune system, so they are usually only prescribed by a dermatologist if other treatments do not work.

Infliximab and adalimumab are immunosuppressive treatments that are given by injection at regular intervals either at home or in hospital.

Steroids

Rarely, you may be prescribed steroids, such as prednisolone, to reduce severely inflamed skin. Steroids can be taken as skin creams or tablets, or you may have an injection directly into affected skin.

Possible side effects of steroids include weight gain, poor sleep and mood swings.

Read more about steroid creams (topical corticosteroids), steroid tablets and steroid injections.

Surgery

Surgery may be considered in cases where hidradenitis suppurativa cannot be controlled with medicine.

Lifestyle advice

If you have hidradenitis suppurativa you should:

• lose weight if you are overweight
• stop smoking if you smoke
• use an antiseptic skin wash or antiseptic soap – this may be prescribed alongside other treatment
• hold a warm flannel on the lumps to encourage the pus to drain
• wear loose-fitting clothes
• avoid shaving affected skin

Outlook

Although hidradenitis suppurativa can persist for many years, if it’s diagnosed early the symptoms can be improved with treatment.

However, the condition can have a significant impact on a person’s everyday life. Having to regularly change dressings and constantly live with the pain and discomfort of the symptoms can affect your quality of life and lead to depression.

Speak to a GP if you’re finding it difficult to cope.

Page last reviewed: 17 March 2023
Next review due: 17 March 2026

Causes and Symptoms of Armpit Boils

Armpit boils

A boil (also known as a furuncle) is caused by an infection of a hair follicle or oil gland. The infection, usually involving the bacterium Staphylococcus aureus, builds up in the follicle in the form of pus and dead skin. The area will become red and raised, and will slowly grow as additional pus builds up within the lesion.

While unsightly and uncomfortable, most boils are not life-threatening and may open and drain on their own within two weeks. If the boil under your arm grows rapidly or does not improve in two weeks, see your doctor. Your boil may need to be surgically lanced (opened by cutting a small incision).

A boil forms when a bacterial infection — most commonly a staph infection — occurs within a hair follicle. The infection affects the hair follicle and the tissue around it. The bacterial infection causes a hollow space around the follicle that fills with pus. If the area of infection increases around the hair follicle, the boil will grow larger.

Symptoms of a boil include:

• red, pinkish bump
• pain on or around the bump
• yellow pus showing through the skin
• fever
• sick feeling
• itching on or around boil

Several interconnected boils are called a carbuncle. A carbuncle is a large area of infection under the skin. The infections result in a group of boils appearing as a larger bump on the surface of the skin.

Boils under the arm occur when a hair follicle becomes infected. This may occur due to:

• Excessive sweating. If you sweat more than normal due to the weather or physical activity, but you don’t clean yourself properly, you may be more susceptible to infections such as boils.
• Shaving. Your underarm is a place where sweat and dead skin can build up. If you shave your armpits often, you could have higher likelihood of contracting a bacterial infection in your armpit. When you shave, you may be accidentally creating openings in the skin under your arms which can allow bacteria easier access.
• Poor hygiene. If you do not wash under your arms regularly, dead skin can build up which may contribute to the development of boils or pimples.
• Weak immune system. If you have a weak immune system, your body may be less able to fight off a bacterial infection. Boils are also more common if you have diabetes mellitus, cancer, eczema or allergies.

Do not pick at, pop, or squeeze your boil. Among other negative results, popping your boil may cause the infection to spread. Also, squeezing the boil may allow additional bacteria to enter the lesion from your hands or fingers.

To help your boil heal:

• Use antibacterial soap to clean the area.
• Apply moist, warm compresses to the area several times a day.
• Do not attempt to pop the boil.

If your boil does not go away after two weeks, you should get treatment from a medical provider. Your doctor may cut the boil open to drain the pus. You may also be prescribed antibiotics to heal the underlying infection.

You may be wondering whether the bump in your skin under your arm is a boil or a pimple. A pimple is characterized by an infection of a sebaceous gland. This gland is closer to the top layer of the skin (epidermis) than a hair follicle. If a pimple is raised, it will likely be smaller than a boil.

A boil is an infection of the hair follicle which is located deeper in the second layer of skin (dermis), closer to the fat tissue beneath your skin. The infection then pushes out to the top layer of the skin creating a larger bump.

While uncomfortable, boils under your arm are not usually anything to worry about. The boil will most likely improve or heal itself within two weeks.

If you boil grows larger, sticks around for more than two weeks or causes you to have a fever or intense pain, talk to your doctor. You might need a prescription for antibiotics or your doctor might open and drain your boil.

Seals under the arm – a symptom of what disease and which doctor to contact, symptoms of breast cancer – November 14, 2022

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This is how a person works: when something happens to us, we surf the Internet and see there that we are most likely the end. So the seal in the armpit often plunges women into horror – and for good reason. But it’s too early to lament, there can be at least three reasons for this condition, and only one of them poses a serious threat to your health. Our colleagues from Wday.ru and the editors of the City Portals asked the doctors what such a symptom could mean and how to act to protect themselves.

Don’t immediately think of the worst. A common cause of neoplasms in the axillary region is hidradenitis .

Hidradenitis – purulent inflammation of the apocrine sweat glands. The disease develops gradually. The first few days, the inflamed gland is a dense, painful nodule the size of a pea. After 5-7 days, it increases in size up to 2-3 centimeters and acquires a pear-shaped shape.

Inflammation is usually provoked by streptococcus or Staphylococcus aureus, which penetrate the sweat glands through the injured surface of the skin. Also, the appearance of a seal may be associated with a hereditary predisposition and even the use of antiperspirants. Most at risk are women between the ages of 20 and 30.

You can also feel the ball in the armpits due to inflammation of the lymph node , this can occur due to illness and against the background of a decrease in immunity.

The most dangerous disease, which can be indicated by a dense neoplasm in the axillary region, is breast cancer .

— Breast cancer is asymptomatic. But since 90% of cancer cases are a nodular form, it manifests itself precisely in the presence of a node – a dense formation in the mammary gland. It can be felt. Even the first stage is a tumor up to 2 cm in size, 2–5 cm is the second stage, the third stage is when the tumor is larger than 5 cm. Less commonly, cancer may be accompanied by discharge from the chest. Bloody discharge from the nipples is a serious reason to see a doctor, – said in an interview for NGS.RU head of oncosurgical hospital Maxim Shumbasov .

But patients with this diagnosis usually do not complain about pain. Therefore, if you have a seal, but nothing hurts, it is still a reason to undergo an examination.

– Patients do not complain that their chest hurts. Maybe only in a small number of women, but, most likely, it is not the chest that hurts, but intercostal neuralgia is manifested. We had cases when the tumor disintegrated and self-amputation of the mammary gland occurred. But even here the woman felt no pain. But this is already an extremely neglected case,” says Shumbasov.

Initially, the tumor can be felt by yourself. Regular self-examination will help.

– The first stage – a tumor up to 2 cm – this is just the size of a small walnut or hazelnut, it resembles a bone in density. It’s easy to find it. Self-examination is an important aspect, and half of the women find education themselves. It happens that the seal goes away with the onset of menstruation, but if it persists for a month, this is a direct path to the doctor. In general, there is such a problem that women often understand that there is an education in the breast, but do not attach any importance. Or afraid to go. But it’s important to know that self-examinations aren’t about finding cancer, they’re about making sure you’re okay, he concludes.

But not all tumors can be detected by self-examination. Small neoplasms are often not palpable, which means they go unnoticed.

— Don’t miss regular screenings if you don’t have symptoms. It is early diagnosis that is the most effective measure in the fight against breast cancer. The most informative diagnostic method is MRI screening. It allows in 99% of cases to detect a tumor, the size of which can be no more than 4 mm, – says head of the clinic of mammology of the European Medical Center Irina Vasilyeva .

By the way, men also get breast cancer, but very rarely, 5-7 cases a year. The source of breast cancer is not the adipose tissue of the organ, but the glandular tissue, the one where, in other words, milk is formed.

– Risk factors are the same – obesity, injuries, alcohol consumption. Especially beer in large quantities – because there is a hormone estrogen. In men, this glandular tissue is developing, – explains the head of the oncosurgical hospital Maxim Shumbasov.

Obstetrician-gynecologist Simon Paronyan focuses on the prevention of aggressive cancer. He believes that simple tests can prevent debilitating treatment and save lives.

— Why am I so excited about this topic. Recently, three women came to see me, 39, 40, 42 years old, all with suspected breast cancer. Unfortunately, the diagnosis was confirmed. Now the patients will have a new stage of life and, I hope, they will succeed,” he said. – And I, as a doctor, want to ring all the bells. I noticed that the incidence of breast cancer has increased significantly. The number of benign and malignant tumors also increased. I attribute this to covid – after the pandemic, the incidence of cancer has tripled, and these are not unfounded declarative statements, this is what oncologists say.

According to the obstetrician-gynecologist, women under 40 years old should have an ultrasound of the mammary glands once a year on the 6-13th day of the cycle. From 40 years and older – a mammogram is shown once a year. It’s a must, it’s a must.

— My dear women, I ask you to help us so that later we can help you. Do not forget to visit the doctor, undergo an examination once a year: ultrasound / mammography, ultrasound of the pelvic organs on the 5-7th day of the cycle, tumor markers CA-15.3, CEA, smears for oncocytological examination + tumor marker CA-125. All this is available, and it must be done, he concludes.

We recently talked about other tests women over 40 should have.

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