How to Treat Hidradenitis

Hidradenitis suppurativa, or HS, is a chronic, inflammatory disease of the skin. The disease causes blackheads, cysts and abscesses in areas of the body like the underarms and groin, where there are hair follicles and apocrine sweat glands. Due to the chronic pain and draining pus-filled boils, hidradenitis is a physically, socially and psychologically disabling disease. Control of hidradenitis includes dietary and lifestyle modifications, medical and surgical treatments.

Instructions

Self-Treatment

• 1

  Stop smoking because HS is extremely difficult to control in smokers. Avoid nicotine replacement products. It is not known how smoking affects HS but 70 percent of HS patients have a history of smoking or are smoking presently. Nicotine replacement products can also exacerbate HS.

• 2

  Modify your diet to lose weight, since obesity is a strong risk factor for developing HS. Eliminate all milk and dairy products because the hormones may worsen HS. Eat foods that have a low glycemic index -- do not quickly raise your blood sugar -- as HS is related to your body's inability to process blood sugar correctly.

• 3

  Reduce trauma to the affected areas. Wash the areas gently with a mild cleanser. Avoid washcloths, sponges or loofahs. Wear loose, breathable clothing that reduces heat, sweating and friction.

Medical Treatment

• 4

  See your dermatologist early in the course of the disease, as quick treatment may prevent sinus formation and scarring. Find out if there is a family history of similar lesions, as hidradenitis is a hereditary disease.

• 5

  Ask your doctor to evaluate you for hormonal abnormalities and insulin resistance, particularly if there is a history of irregular menses, difficulty becoming pregnant, acne, hair loss or excessive hair growth. Polycystic ovary syndrome and hidradenitis suppurativa often occur together.

• 6

  See a doctor to have the early cysts and abscesses unroofed before they become chronic, draining sinuses. Unroofing is a surgical procedure where the cyst or abscess is opened and left to heal from the inside out. The doctor may also inject lesions with intralesional triamcinolone to reduce inflammation and pain of the cysts.

• 7

  Talk to your doctor about spironolactone, a medication that counteracts male-like hormones (androgens). Because HS is often related to hormonal imbalances, anti-androgens like spironolactone should be considered as first-line therapy.

• 8

  Talk to your doctor about adding antibiotics to the HS treatment regimen, as antibiotics can both kill bacteria and block inflammation in HS.

• 9

  Consider chronic immunosuppressive medications, like TNF alpha inhibitors for management of severe refractory HS. Consider wide local excision and secondary intention wound healing for areas not responding to above therapies.