Hidradenitis Suppurativa Affects 2% of Americans. Most Have Never Heard of It.
Hidradenitis suppurativa affects up to 2% of Americans and is often mistaken for acne. Dermatologists explain symptoms, causes, and treatments including the 2023 FDA-approved biologic Cosentyx.
Updated
The takeaway
- Hidradenitis suppurativa affects up to two percent of the US population, according to the HS Foundation.
- Women are twice as likely as men to have the condition, and Black people are three times more likely than white people, per a 2021 study in the International Journal of Women's Dermatology.
- In 2023, the FDA approved Cosentyx to treat moderate to severe hidradenitis suppurativa, and Dr. Michael Rosenblum predicts new therapies within five to 10 years.
Hidradenitis suppurativa affects up to two percent of the US population, according to the HS Foundation — yet the condition remains far less discussed than eczema or psoriasis.
A 2021 study published in the International Journal of Women's Dermatology found that women are twice as likely as men to have the condition, and Black people are three times more likely to have it than white people. Despite those numbers, many patients mistake the condition for ordinary acne, delaying proper care.
Here is what dermatologists say patients and beauty professionals should know.
What Is Hidradenitis Suppurativa?
Hidradenitis suppurativa, also known as acne inversa, is a chronic inflammatory skin disease. "You may get cysts or boils, usually in folded areas of the skin, like the armpits, groin area, or under the breasts," says dermatologist Ife J. Rodney, MD, founding director of Eternal Dermatology + Aesthetics.
Acne inversa differs from the more common acne vulgaris in a key way: it typically affects the deeper layers of the skin, whereas acne vulgaris shows outwardly through blemishes like pimples.
According to the American Academy of Dermatology (AAD), the condition can worsen without treatment. When an abscess breaks open, blood and pus leak out. A scar often develops as it heals. Patients may develop more abscesses in the same area, and pus-filled tunnels called sinus tracts can form under the skin, Dr. Rodney says.
"Some forms are quite mild and easily treatable, while others require surgery and adequate pain control," says Michael Rosenblum, MD, PhD, dermatologist, skin immunology researcher, and professor of dermatology at the University of California, San Francisco. "It tends to be a relapsing and remitting disease that is all on a spectrum."
What Causes It?
The exact cause is unknown. Many experts believe the condition is linked to blocked hair follicles under the skin, Dr. Rosenblum says. "The blocked hair follicles trap bacteria, which leads to inflammation and rupture." Genetics, environmental factors, and hormonal changes may play a role in why the blockages occur.
"For patients with hidradenitis suppurativa, the inflammation doesn't go away and starts to feed on itself — it gets worse and worse," Dr. Rosenblum says. He describes the condition as "an inability to control the inflammation."
The condition is not contagious. "Many cases can be pretty striking in appearance, but you cannot get hidradenitis suppurativa from another person," Dr. Rodney says. The AAD also notes it is not a sexually transmitted disease and is not caused by unclean skin.
Symptoms to Watch For
Dr. Rodney lists the common signs:
- Small, pitted areas of skin that contain blackheads
- Painful lumps that grow and break open
- Abscesses that drain fluid and pus
- Itchy abscesses that may have an odor
- Abscesses that heal very slowly and happen again over time
Mild cases may involve one or a few lumps in a single area. Moderate cases usually include lumps in different areas that recur and break open. Severe cases can involve widespread lumps, scars, and chronic pain.
Diagnosis and Treatment
Doctors usually diagnose the condition clinically, after a physical exam. "When patients come in, we can usually tell right away whether they have it or not," Dr. Rosenblum says. A skin biopsy may be performed if symptoms could point to another condition.
"Sometimes, the condition can be very mild, where it may just include one or two cysts that come and go — those can be more difficult to diagnose," Dr. Rodney says. "The more severe cases with larger cysts are easier to spot."
Treatment options include antibiotics to reduce bacteria contributing to inflammation, and steroids. "We frequently do steroid injections into the cysts to shut down the inflammatory process," Dr. Rodney says. "That's very helpful, especially if you get it injected as soon as the cyst appears versus when it's larger and really painful."
In more severe cases, a biologic medication — made from living organisms such as plasma or growth factors — can help control inflammation, Dr. Rosenblum says. Surgery may be needed to remove lumps and scars. Lifestyle adjustments during flare-ups include wearing loose-fitting clothes, avoiding heat and humidity, and preventing skin injury.
The Long-Term Outlook
The condition is lifelong. "If you have hidradenitis suppurativa, you have it for life," Dr. Rodney says.
Still, the treatment pipeline is expanding. In 2023, the FDA approved Cosentyx for moderate to severe hidradenitis suppurativa, and research is exploring new targeted therapies. "There's been a real explosion in the science of trying to understand this disease," Dr. Rosenblum says. "Over the next five to 10 years, there should be new therapies."
Source: PopSugar Beauty; Source: hs-foundation.org
Olivia Hart
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Senior reporter covering business strategy at Eurasian Beauty Journal.
