Hidradenitis suppurativa (HS) is a disease that causes swollen, painful bumps to form on the skin. Most of the time, these bumps appear near hair follicles and sweat glands, especially in areas where skin rubs against skin, like under your armpits or on your inner thighs.
For a small amount of people with HS, the bumps appear on the face. HS on your face can affect your appearance, especially if you have a lot of bumps or they’re very large.
The lumps may become swollen and painful as pus builds inside them. If you don’t get treatment for the bumps, they can harden and form thick scars and tunnels underneath your skin.
HS looks like acne, and the two conditions often occur together. Both start from inflammation in the hair follicles. One way to tell the difference is that HS forms rope-like scars on the skin, while acne doesn’t.
Doctors don’t know exactly what causes HS. It starts in your hair follicles, which are the little sacs under the skin where hair grows.
The follicles, and sometimes nearby sweat glands, become blocked. Oil and bacteria build up inside, causing swelling and sometimes a leaking fluid that smells bad.
Hormones may play a role in HS since it often develops after puberty. An overactive immune system may also be involved.
Certain factors make you more likely to get HS or worsen the disease, including:
- being overweight
- taking the drug lithium, which treats bipolar disorder
People with Crohn’s disease and polycystic ovarian syndrome are more likely to get HS than people who don’t have these conditions.
HS doesn’t have anything to do with hygiene. You can have very good personal hygiene and still develop it. HS also doesn’t spread from person to person.
Your doctor will base your HS treatment on the severity of your breakouts, and where on your body you have them. Some treatments work on your whole body, while others focus on clearing up your face.
An over-the-counter acne medication or wash may be enough to clear mild HS on your face. Using an antiseptic wash such as 4 percent chlorhexidine gluconate each day may also help relieve the bumps.
For isolated bumps, place a warm wet washcloth on them and hold for about 10 minutes at a time. Or, you can soak a teabag in boiling water for five minutes, remove it from the water, and once it’s cool enough to touch, place it on the bumps for 10-minute intervals.
For more widespread or severe breakouts, your doctor may recommend one of these medications:
- Antibiotics. These medications kill the bacteria in your skin that cause swelling and infections. Antibiotics can stop the breakouts you have from getting worse, and prevent new ones from starting.
- NSAIDs. Products like ibuprofen (Advil, Motrin) and aspirin can help with the pain and swelling of HS.
- Corticosteroid pills. Steroid pills bring down swelling and prevent new bumps from forming. Yet, they can cause unpleasant side effects like weight gain, weak bones, and mood swings.
In some cases, your doctor may recommend the use of off-label treatments for HS. Off-label drug use means that a drug that has been approved by the Food and Drug Administration (FDA) for one purpose is used for a different purpose that has not been approved.
Off-label treatments for HS can include:
- Retinoids. Isotretinoin (Absorica, Claravis, others) and acitretin (Soriatane) are very strong vitamin A-based drugs. They treat acne too and can be helpful if you have both conditions. You can’t take these medications if you’re pregnant because they increase the risk of birth defects.
- Metformin. This diabetes drug treats people who have both HS and a cluster of risk factors called metabolic syndrome.
- Hormone therapy. Changing hormone levels may set off HS outbreaks. Taking birth control pills or the blood pressure drug spironolactone (Aldactone) can help regulate your hormone levels to control outbreaks.
- Methotrexate. This cancer drug helps regulate the immune system. It may be helpful for severe cases of HS.
- Biologics. Adalimumab (Humira) and infliximab (Remicade) calm the overactive immune response that contributes to HS symptoms. You get these drugs by injection. Because biologics are powerful drugs, you’ll only get them if your HS is severe and hasn’t improved with other treatments.
If you have a very large growth, your doctor may inject it with corticosteroids to bring down the swelling and reduce pain.
Doctors sometimes use radiation therapy to treat severe HS of the face and other areas of the body. Radiation may be an option if other treatments haven’t worked.
Very severe breakouts may require a surgical procedure. Your doctor can drain large bumps, or use a laser to clear them up.
Certain foods and other products may make your HS symptoms worse. Ask your doctor if you should consider cutting these items from your daily routine:
- Cigarettes. In addition to its many other harmful effects on your health, smoking triggers and worsens HS breakouts.
- Razors. Shaving can irritate the skin in areas where you have HS bumps. Ask your dermatologist how to remove facial hair without causing more breakouts.
- Dairy products. Milk, cheese, ice cream, and other dairy foods raise levels of the hormone insulin in your body. When your insulin levels are high, you produce more of the sex hormones that aggravate HS.
- Brewer’s yeast. This live, active ingredient helps ferment beer and make bread and other baked goods rise. In one
small study of 12 people living with HS, cutting out these foods improved skin lesions in HS.
- Sweets. Cutting out sources of added sugar, like candy and cookies, may lower your insulin levels enough to improve HS symptoms.
HS is a chronic condition. You may continue to have breakouts throughout your life. Though there is no cure, starting on a treatment as soon as you can will help you manage your symptoms.
Managing HS is important. Without treatment, the condition can affect your appearance, especially when it’s on your face. If you feel depressed because of the way HS makes you look or feel, talk to your dermatologist and seek out help from a mental health professional.