Hidradenitis Suppurativa/Acne Inversa

By Sofia Wehabey, MBS 2019, Geisinger Commonwealth School of Medicine

Mentor: Michael Bordonaro


Many of us are unfamiliar with the term Hidradenities Suppurativa (HS). HS is hard to recognize, so while individuals have the disease, it is common to make an incorrect diagnosis. As a result, HS is labeled as a rare disease. HS is also known as acne inversa, which is very confusing since HS is not a type of acne. So you ask, why is it called acne inversa? Well, the scientific and medical community justifies that HS, although not a type of acne, has characteristics similar to acne that the majority of us get during or after puberty.

What is Hidradenitis Suppurativa? HS is a long-term skin condition that presents in areas of the body where there is high skin fold or skin rubbing such as armpits, under the breast, inner thigh, bullocks, and genital area. HS is also associated with sweat glands that contains fluid that is present in areas of the body with abundant hair follicles. The appearance and severity of HS differ from patient to patient, however, to give a general picture, it usually appears as a red, large pimple that contains pus, it is very painful, and it has an unpleasant odor. It also continues to re-emerge. Most HS patients find the symptoms embarrassing and repulsive, and they isolate themselves from society.

What causes Hidradenitis Suppurativa? Currently, the scientific/medical community does not have an answer. However, multiple studies have identified some exposures associated with HS. For example, obesity/diet, smoking, mechanical stress, sex hormones, and genetic factor are a few of the exposures that contribute to HS. Similar to many diseases, HS can be passed down from a family member. Nicotine, a chemical in tobacco, promotes closing of follicular openings and reduces the number of sweat glands which is a characteristic of HS. It has also been confirmed that sex hormones such as androgen and testosterone are found in excess in patients with HS. The overlapping skin folds in obese individuals leads to sweat retention causing irritation and leading to skin swelling. In addition, the humid and warm microenvironment in skin folds favors the growth of bacteria causing infections, leading to redness and swelling of the skin and increasing the risk of HS. In addition, mechanical factors such as friction, rubbing and pulling cause micro-tearing of hair follicles. Micro-tearing of the follicles leads to skin inflammation and pimple formation.

Is there a treatment for it? Currently, there is no cure for HS; however, there are treatments that reduce the burden of the disease. Surgery is one of the best options to treat HS. Through surgery, the swollen pimple is cut open and drained. There are also creams and antibiotics that are applied to the infected skin. Also improving and maintaining a healthy lifestyle, such as exercising, healthy diet, and avoiding tobacco use help manage HS.

Overall, the presence of HS is physically and mentally troublesome for the patients. Therefore, it is important that extensive research is done to address many questions and confusions in understanding the disease.