Lots of skin conditions can have striking appearances that can affect, not only the physical health of a person but also the emotional well-being. Years ago, a commercial ad lamented the “heartbreak of psoriasis.” Just as damaging to one’s self-esteem is the skin inflammation known as hidradenitis suppurativa (HS). More than three million U.S. citizens suffer from the disease. It usually begins in late teenage or early adult years, and may be a lifelong problem.

Hidradenitis suppurativa is a condition that causes bumps to form anywhere skin rubs together. Areas affected include the groin, inner thighs, armpits, under the breasts, and on the buttocks. These bumps tend to be painful, grow, and break open. Different parts of the body can be affected at the same time.

Besides painful bumps (usually small) that last for weeks or months, symptoms include:

•             Pitted areas with blackheads

•             Fistulas (tunnels which form in the skin and leak pus)

•             Foul odors from infected areas

All of the above combine to make life difficult for sufferers. It should be noted that HS is not caused by poor hygiene and even infection, although bacterial infection is a common complication.

Hidradenitis seems to run in families; women are more often affected than men. Obesity, hot environments, smoking, and age are additional risk factors. As it tends to start sometime after puberty, the condition may cause significant stress and depression due to the symptoms and subsequent scarring that occurs.

Long-term, hidradenitis suppurativa may block lymphatic drainage, causing swelling of extremities and other areas, even the genitals. This may limit the range of motion of extremities and make walking or even sitting uncomfortable.  Hidradenitis sufferers often cover trouble areas with dressings, but these tend to leak and can be difficult to secure in place.  

Mild cases may be treatable with antibiotic creams to fight infection and ibuprofen to decrease inflammation. Oral antibiotics such as clindamycin or doxycycline may be required for more moderate disease. In the worst cases, some surgical procedures are suggested:

•             Fistulas under the skin are “unroofed” to expose and allow drainage.

•             Surgical excision of a small but significantly painful area.

In normal times, injectable drugs like adalimumab (Humira), oral steroids or retinoids, laser surgery, and other modern options exist. At this point, none are considered permanent cures.

Natural remedies abound for HS, but the evidence supporting their use is very limited. They include:

• Neem oil (apply with a cotton ball and wash off after a short time)
• Tea Tree oil (mix 3-4 drops with 2 tablespoons of a carrier oil like olive or coconut and apply to affected areas with a cotton ball)
• Green tea compresses (apply a wet tea bag directly over problem areas for 10 minutes)
• Raw unprocessed honey (mix 1 tablespoon with 1 tablespoon turmeric, ½ tablespoon of carrier oil, and apply for 15-20 minutes before washing off.)
• Zinc (oral supplement or make a cream with 1 tablespoon zinc oxide powder, ½ cup carrier oil, and 1 tablespoon of beeswax)
• Aloe vera (topically)
• Vitamin D (oral supplement)
• Rubbing alcohol (use with a cotton pad, but not on open sores due to burning sensations)
• Neem oil (apply with a cotton ball and wash off after a short time)
• Apple cider vinegar (apply with a cotton ball)

Lifestyle changes involve changing the diet to maintain a normal weight for height and age, as well as to exclude dairy, bread, beer (due to the yeast), and sugars. Adding anti-inflammatory foods may also help, such as:

• Green tea
• Tree nuts like walnuts
• Fatty fish like salmon
• Ginger
• Fresh fruits and vegetables

Although prevention of flare-ups is difficult, those who wear loose cotton clothing, keep affected areas as dry as possible, and maintain proper hygiene seem to do best. As many experience irritations from shaving armpits and groin areas, permanent hair removal procedures may be an option. It’s important to avoid the urge to pop and drain lumps, which often make the situation worse.

Some people claim bleach baths help chronic skin infections such as hidradenitis, eczema, and others. Because of the harsh nature of bleach, however, patients should be aware that some may find they are more irritated afterwards. If you decide to try this method, add ¼ cup of standard household bleach to a tub half-filled or more with water. Soak for 10 minutes before rinsing off with clean water and drying. This strategy should not be a daily routine.

Joe Alton MD

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