July 25, 2024

Hidradenitis suppurativa (HS) is a chronic skin condition that causes lesions, such as painful bumps and pus-filled lumps under the skin. While a blockage in your hair follicles can increase your risk of developing this condition, the exact cause of HS is unknown. That makes prevention of this skin disease a bit challenging.

However, lifestyle habits, proper skincare, and certain medications can all lower your risk of experiencing flares—or periods where symptoms of HS are most active.

Research estimates that up to 4% of the global population lives with HS. The condition seems to be more common among people 21-29 years old, and people assigned female at birth are more likely to develop HS than their male counterparts.

Other common risk factors include:

  • A family history of HS
  • Smoking tobacco
  • Increased skin friction due to obesity
  • Other inflammatory conditions (e.g., Crohn’s disease, psoriasis)

Studies show that hidradenitis suppurativa tends to run in families. About 33-40% of people with HS have a first-degree relative, such as a parent or sibling, with the condition. Research suggests that mutations in the gamma-secretase complex, which plays a key role in Notch signaling, often increase the risk of HS. Notch signaling has several important functions, including cell growth, cell differentiation, and apoptosis (cell destruction).

The following genes that make up the gamma-secretase complex may develop mutations that can increase your risk of developing HS:

  • Nicastrin (NCSTN)
  • Presenilin 1 (PSEN1)
  • Presenilin enhancer 2 (PSENEN)

HS also seems to have an autosomal dominant transmission pattern, which essentially means that only having one parent with this gene mutation is enough for them to pass the mutation on to you and increase your risk of HS.

Some research also shows that other gene mutations may play a role in the development of HS. These genes include kruppel-like factor 5 (KLF5), SRY-box transcription factor 9 (SOX9), proline-serine-threonine phosphatase interacting protein 1 (PSTPIP1), and dermcidin (DCD).

While there is no cure for HS at this time, there are several things you can do to improve symptoms, reduce the frequency of flares, and slow down disease progression. Your exact treatment and prevention plan will depend on the severity of your symptoms, but healthcare providers often recommend lifestyle habits, proper skincare, and medications. In severe cases, medical procedures may be necessary.

Lifestyle Habits

Because certain lifestyle habits can increase your risk of developing HS, making some changes to your daily life may help reduce symptoms. Consider the following adjustments:

  • Avoid smoking, including cigarettes, hookah, or tobacco
  • Eat nutritious foods to manage a weight that’s right for you
  • Limit strenuous activities in hot or humid places to prevent flares

Skincare

Your healthcare provider may also recommend several skincare approaches to prevent injuries or irritation to the skin lesions, as the inflammation can worsen HS. They may offer the following suggestions:

  • Use antimicrobial soaps: Antimicrobial washes help reduce the bacteria in your skin and limit the risk of skin infections. Body washes that include ingredients like benzoyl peroxide or zinc pyrithione can effectively reduce skin bacteria.
  • Don’t scrub the skin: Scrubbing the affected area of the skin can cause inflammation, which can worsen HS.
  • Avoid waxing skin: Dermatologists (or doctors who specialize in skin conditions) recommend that people with HS avoid waxing the hair on their skin, as this can irritate your lesions and worsen symptoms.
  • Try warm compresses: To reduce any pain associated with HS, apply a compress (such as a heating pad or warm towel) to your skin lesions.
  • Limit deodorant use: Many deodorants and antiperspirants may contain ingredients such as alcohol, fragrances, baking soda, dyes, and parabens—all of which can irritate the skin. Instead, dermatologists recommend using mild or organic versions of deodorants.
  • Keep sweating at bay: Because skin friction can worsen symptoms, staying in cool or shaded areas, drinking plenty of water, and wearing loose-fitting fabrics can help.
  • Try laser hair removal: This has been shown to prevent the development or progression of HS in the treated areas.

Medications

Your dermatologist may recommend several medications to improve your HS symptoms and keep flares at bay. In mild cases, they may recommend topical medications that you can apply directly to your skin. Other times, oral medications (taken by mouth) may be required.

  • Topical medications: Medicines such as Clindagel (clindamycin) and Acnotex (resorcinol) can reduce the risk of infections and limit inflammation.
  • Oral medications: Antibiotics such as Actisite (tetracycline) and Rifdain (rifampicin) can improve moderate to severe HS symptoms. Anti-inflammatory agents such as Neoral (cyclosporine) may reduce inflammation. Biologics such as Remicade (infliximab), Humira (adalimumab), and Cosentyx (secukinumab) can limit inflammation and pus formation. Janus kinase (JAK) inhibitors show promise when used off-label, meaning they’re not approved to treat HS.

Medical Procedures

If your hidradenitis suppurativa is severe, your dermatologist may recommend certain procedures to improve symptoms and prevent additional flares from occurring. These may include:

  • Getting corticosteroid injections
  • Draining the pus out of some lesions
  • Fully removing lesions with a medical knife
  • Deroofing (removing the skin) from the top of the lesions
  • Trying laser surgery

It’s worth noting that these preventative treatments are only necessary if you have serious symptoms that are extremely painful or recur despite using other prevention and treatment methods.

If the lumps and bumps on your skin are starting to resemble pus-filled boils or if you have a family history of HS, talk to your healthcare provider. They can assess your symptoms, provide you with a proper diagnosis, and recommend treatment and prevention strategies.

Your provider will check for symptoms like inflammation, pain, and pus build-up. While some primary care providers can diagnose you, you’ll likely be referred to a dermatologist (skin, hair, and nail specialist) for further support and care.

The exact cause of hidradenitis suppurativa is unknown, so healthcare providers don’t have surefire ways to prevent the condition. However, several prevention strategies can limit the frequency of symptom flares (periods when HS symptoms are most active and painful).

Your healthcare provider may recommend strategies such as lifestyle changes, skincare techniques, and certain medications or procedures to reduce symptoms and improve your quality of life.

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