Hidradenitis suppurativa commonly occurs around hair follicles where many oil and sweat glands are found, such as the armpits, groin and anal area. It may also occur in areas where skin rubs together, such as the inner thighs, under the breasts or between the buttocks. Hidradenitis suppurativa can affect a single area or multiple areas of the body.

Signs and symptoms of hidradenitis suppurativa include:

• Small pitted areas of skin containing blackheads, often appearing in pairs or a "double-barrel" pattern.
• One or more red, tender bumps (lesions) that fill with pus. The bumps often enlarge, break open and drain pus. The drainage may have an unpleasant odor. Itching, burning and excessive sweating may accompany the bumps.
• Painful, pea-sized lumps that grow under the skin. These hard lumps, which may persist for years, can enlarge and become inflamed.
• Painful bumps or sores that continually leak fluid. These open wounds heal very slowly, if at all, often leading to scarring and the development of tunnels under the skin.

Hidradenitis suppurative often starts at puberty with a single, painful bump that persists for weeks or months. For some people, the disease progressively worsens and affects multiple areas of their body. Other people experience only mild symptoms. Excess weight, stress, hormonal changes, heat or excessive perspiration can worsen symptoms. 

When to see a doctor
Mild cases of hidradenitis suppurativa may be treated with self-care measures. But if the condition doesn't improve in one to two weeks, appears in several locations, recurs often or is painful, consult your doctor or a dermatologist. Most often, medical treatments — such as prescription medications or surgery — are necessary to manage the problem.

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Hidradenitis suppurativa occurs deep in the skin around oil (sebaceous) glands, apocrine sweat glands and hair follicles. The apocrine sweat glands release fluid, dead skin cells and other substances into the hair follicle. This mixes with the oil from the sebaceous gland. Hidradenitis suppurativa develops when the oil glands and hair follicle openings become blocked with these substances. When oils and other skin products become trapped, they push into surrounding tissue. Bacteria can then trigger infection and inflammation.

It's not known why this blockage occurs, but a number of factors — including hormones, genetics, cigarette smoking and excess weight — may all play a role.

Sometimes hidradenitis suppurativa occurs with other diseases, such as Crohn's disease, herpes simplex or Grave's disease.

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Anyone can develop hidradenitis suppurativa — it occurs equally among all races and ethnic groups. But based on what's currently known, the following factors appear to be more commonly associated with the disease:

• Sex. Women are more likely to develop hidradenitis suppurativa. Why this occurs is unknown.
• Age. Hidradenitis suppurativa usually occurs between puberty and age 40. It rarely affects children, but can occur in adults older than 40.
• Genetic factors. Having a family history of hidradenitis suppurativa increases your risk of developing the disease.

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Hidradenitis suppurativa often causes complications when the disease is persistent and severe. These complications include:

• Sinus tracts or tunnels that connect and form a network under the skin. The tracts prevent the sores from healing and cause more sores to develop.
• Scars and skin changes. Severe hidradenitis suppurativa may leave thick, raised scars, pitted skin or patches of skin that are darker than normal (hyperpigmentation).
• Restricted movement. The disease may cause limited or painful movement, especially when it affects the armpits or thighs.
• Cellulitis. This potentially serious bacterial infection appears as an area of swollen, red skin that feels hot and tender and that may spread rapidly. Although the initial infection may be superficial, it eventually can affect the tissues underlying your skin or spread to your lymph nodes and bloodstream.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

You're likely to start by first seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a specialist in skin diseases (dermatologist).

Because appointments can be brief, and because there's often a lot to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do
Write down all your signs and symptoms and when they first occurred. Record how long the lesions lasted and if any recurred.

Make a list of all medications, including vitamins, herbs and over-the-counter drugs that you're taking. Even better, take the original bottles and a written list of the dosages and directions.

If possible, take along a family member or friend. It can be difficult to absorb all the information provided to you during an appointment. The person who accompanies you may remember something that you forgot or missed.

Write down questions that you want to ask your doctor. Don't be afraid to ask questions or to speak up when you don't understand something that your doctor says. Start with the problems that concern you most. If you run out of time, ask to speak with a nurse or physician's assistant or leave a message for your doctor.

If you have symptoms of hidradenitis suppurativa, questions you may want to ask include:

• What is likely causing my symptoms?
• What are other possible causes for my symptoms?
• What tests do I need to confirm the diagnosis?
• Is this condition temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary treatment approach that you're suggesting?
• Is there a generic alternative to the medicine you're prescribing me?
• What if I just wait to see if my signs and symptoms go away on their own?
• Do you have any literature on this condition? Is there a Web site you can recommend where I can learn more?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:

• When did your symptoms first start?
• Did they come on suddenly or gradually?
• What did the lesions look like when they first started?
• Are your symptoms painful?
• What, if anything, makes it better?
• What, if anything, makes it worse?
• Do you have other symptoms that started about the same time?
• What medications do you take?

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

To make a diagnosis, your doctor may ask about your symptoms and medical history, examine your skin, and order blood tests. If pus or drainage is present, your doctor may send a sample of the fluid to a laboratory for testing. This test is known as a culture. Such tests may be necessary to rule out other skin conditions, such as tuberculosis of the skin, a carbuncle or a pilonidal cyst.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

There is no cure for hidradenitis suppurativa. But early treatment can help manage the symptoms and prevent new lesions from developing.

Treatments depend on the extent of the affected areas and whether the sores are painful or infected. Mild cases can be treated with self-care measures, including warm compresses and regular washings with antibacterial soap. Moderate cases may require medications, such as those you rub on the affected areas (topical medications) or those you take by mouth (oral medications). Possible medications include:

• Antibiotics to treat infection. Antibiotics taken for a long time early in the disease may prevent future outbreaks or prevent the disease from worsening.
• Oral retinoid medications to stop oil gland functions and to prevent the plugging of the hair follicle.
• Nonsteroidal anti-inflammatory drugs to reduce pain and swelling.
• Corticosteroids or immunosuppressant drugs.

For severe or persistent cases or for deep lesions, surgery may be necessary.

• Incision and drainage. Surgical drainage or removal of the lesions may be an option when the disease involves a single small area. However, this treatment won't prevent the disease from returning and is generally used for short-term relief.
• Uncovering the tunnels or tracts. Cutting away skin and flesh that cover any tunnels or tracts can increase healing of the lesions and minimize scarring. This doesn't prevent the disease from returning in the treated area or another area of the body, however.
• Surgical removal. Surgical treatment of recurrent or severe symptoms involves removal of all involved skin followed by direct closure with skin flaps or with skin grafting (removing skin from one area of your body and attaching it to another). Full surgical removal of the affected areas can treat the disease that is present but doesn't prevent the disease from occurring in other areas.

Obesity, incomplete removal and ongoing skin infections can increase the chances that hidradenitis suppurativa returns, even after surgical treatment.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

The following suggestions may help relieve discomfort, speed healing and prevent the infection from spreading:

• Apply a warm washcloth or compress to help reduce swelling.
• Gently wash the affected areas with antibacterial soap. After washing, apply an over-the-counter antibiotic.
• Wear loosefitting clothes and underwear to prevent skin irritation.
• Avoid shaving the affected areas to prevent skin irritation.
• Don't smoke. No scientific studies have been done on the effects of smoking cessation on hidradenitis suppurativa. However, stopping smoking has many health benefits and may improve the course of the disease.

Excess weight increases the number of areas where skin rubs together — for example, between skin folds — causing friction, increased perspiration and bacterial growth. Though weight loss won't cure the disease, it may improve symptoms.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Zinc gluconate supplements (zinc salts) taken daily may help reduce inflammation and prevent new outbreaks.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

For many, hidradenitis suppurativa is very distressing. This condition can be painful, unsightly and, if the lesions are draining, foul smelling. The ongoing, persistent nature of the disease and the treatment challenges only add to the burden. You might feel embarrassed or anxious about your symptoms and become withdrawn or self-conscious. You may be frustrated or upset by other people's reactions.

If you're having difficulty coping, you may find some of the following suggestions helpful:

• Educate yourself about hidradenitis suppurativa. The more you know, the better prepared you'll be to deal with complications or recurrences. Besides talking to your doctor, you may want to talk to a counselor or medical social worker. Or you may find it helpful to talk to other people with hidradenitis suppurativa.
• Follow your doctor's recommendations. If your doctor recommends certain treatments or lifestyle changes, be sure to follow them. Ask questions if anything is unclear.
• Maintain a strong support system. Family and friends can help you tremendously as you go through this difficult time. Sometimes, though, you may find the concern and understanding of other people with hidradenitis suppurativa especially comforting. Go online to connect with other people living with the condition.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.