Hidradenitis Suppurativa Unit

The abnormal inflammatory reaction characteristic of hidradenitis may be caused by an immune response in which the patient’s own immune system mistakenly attacks the pilosebaceous follicle and skin as if they were harmful agents.

Smoking, obesity and friction are the three main external factors that promote the development of hidradenitis and influence its course

• Smoking has an inflammatory effect and also alters keratin production, promoting follicular occlusion.
• Overweight and obesity worsen symptoms and prognosis, as they are associated with irritation and occlusion in skin folds. In addition, fatty tissue—which is more abundant in people with excess weight—has a clear pro-inflammatory role.
• Friction, associated with wearing tight clothing—especially in poorly breathable fabrics—increases the risk of follicular blockage and worsens skin irritation and inflammation.

Hormonal factors

Because many women experience changes in symptoms and disease progression depending on the menstrual cycle, pregnancy or menopause, it is likely that, at least in some patients, the condition is influenced by hormonal profile.

Pharmacological factors

Certain medications such as lithium, contraceptives or retinoids may increase hidradenitis recurrence.

Genetic factors

It is estimated that around 40% of patients with hidradenitis suppurativa have a first-degree relative affected by the same condition.

At present, hidradenitis suppurativa has no cure, and available treatments are aimed at controlling symptoms, improving disease progression and preventing deterioration of emotional wellbeing and quality of life.

Hidradenitis is characterised by the appearance of lumps that are very painful to touch, resulting from obstruction and rupture of pilosebaceous follicles in typical locations.

In addition to pain, these abscesses—commonly referred to as “golondrinos”—cause itching and/or drainage of a seropurulent fluid that may be more or less thick and malodorous. This can lead to fibrosis and scarring, open comedones, double comedones, fistulas and tunnels beneath the skin.

Lesions associated with hidradenitis suppurativa:

Nodules

Solid, rounded lumps similar to acne lesions, although considerably larger. These nodules are located deep within the skin and are very painful on touch or pressure.

Abscesses

Palpable lesions with less firmness than nodules and larger than typical acne spots. They contain seropurulent material that may drain to the skin surface or into the deeper dermis. They are deep and painful.

Fistulas

Connections between two or more abscesses that leave scars and open lesions on the skin. They are inflamed and often very painful.

Tunnels

Connections between hidradenitis lesions beneath the skin that enlarge the affected area and lead to fibrosis and proliferation of scar tissue.

The nature of typical hidradenitis lesions is often so evident that no specific tests are required beyond observation and physical examination. In this way, the dermatologist specialising in hidradenitis bases the diagnosis mainly on three aspects:

Characteristic lesions of hidradenitis

Abscesses, nodules, fistulas and/or associated scarring.

Typical location

Mainly armpits and groin, although lesions may also appear on the breasts, anogenital area, buttocks, etc.

Course

The patient reports that lesions are recurrent or have become chronic.

Based on these findings, the specialist may classify the condition into different stages according to the Hurley scale, the most widely used classification:

Hurley I. Mild hidradenitis

A small number of painful nodules or abscesses, isolated, usually in the groin or armpits.

Hurley II. Moderate hidradenitis

More numerous abscesses and nodules. Patients may present scarring and fistulous tracts due to recurrence in the same area.

Hurley III. Severe hidradenitis

Very numerous abscesses and nodules, often leading to extensive fistulas and tunnels that may drain to the skin surface, leaving large scars.

The Grupo Pedro Jaén Hidradenitis Suppurativa Unit also uses high-resolution ultrasound to provide a more precise diagnosis regarding the exact nature of lesions, their number and location, the presence of deep cysts that may not be visible on the skin surface, and to delineate affected areas in patients who require surgery. This procedure is non-invasive, which is especially important in paediatric patients or in those cases where malignant nature must be ruled out.

Ultrasound has also proven useful for detecting early signs of inflammation and vascular lesions, as well as for guiding intralesional corticosteroid injections. For this reason, specialists in this unit have incorporated this imaging technique into the management of hidradenitis patients, both for diagnosis and treatment.

Inflammatory bowel disease

Several studies conclude that both conditions may arise through very similar mechanisms. In fact, Crohn’s disease can present with skin lesions similar to those seen in hidradenitis patients.

Diabetes

Patients with hidradenitis seem to have a slightly higher risk of developing insulin resistance and diabetes, a phenomenon also seen in patients with psoriasis.

Abnormal lipid profile

Between 3% and 10% of patients with hidradenitis suppurativa also have LDL cholesterol (“bad” cholesterol) and triglyceride levels above recommended values, making them more vulnerable to certain cardiovascular disorders.

Metabolic syndrome

Metabolic syndrome refers to the combination of pro-inflammatory factors including excess abdominal fat, insulin resistance, hypertension and atherosclerosis. This syndrome increases the risk of cardiovascular disease and type 2 diabetes, and it is more common in patients with hidradenitis suppurativa.

Cardiovascular diseases

Patients with hidradenitis have a higher risk of myocardial infarction or stroke. This is very similar to what occurs in patients with psoriasis. In fact, this factor is investigated and monitored in the Grupo Pedro Jaén Psoriasis and Inflammatory Skin Diseases Unit.

There are multiple treatment lines depending on severity. At the Grupo Pedro Jaén Hidradenitis Suppurativa Unit, we offer all of them, and the dermatologists in the unit can prescribe them individually or in combination depending on each case.

Medications

There are multiple treatment lines depending on severity. At the Grupo Pedro Jaén Hidradenitis Suppurativa Unit, we offer all of them, and the dermatologists in the unit can prescribe them individually or in combination depending on each case.

The first line of treatment aims to control bacterial infection and reduce the inflammatory activity involved in the formation and accumulation of pus within the characteristic abscesses.

In addition, medications are often prescribed to reduce pain, swelling and progression of abscesses and nodules. These drugs may be administered orally or, depending on the case, injected directly into lesions. In such cases, Grupo Pedro Jaén specialists use ultrasound so that the dermatologist can deliver the medication precisely to the target area.

Finally, the specialist may consider prescribing other medications to control associated conditions such as acne, or aggravating factors related to the patient’s immune or hormonal activity.

Advanced treatments for hidradenitis

There are next-generation therapies designed to act locally and selectively on certain cellular markers involved in inflammatory diseases. In hidradenitis, there are therapeutic options that block specific proteins that play a key role in chronic inflammatory processes and are also involved in the activity of certain skin cells responsible for keratin production. These treatments may help reduce existing lesions and prevent new ones from developing.

At present, Grupo Pedro Jaén specialists are investigating the potential benefits of some therapies used in psoriasis treatment to control hidradenitis, as both diseases share many inflammatory mechanisms and pathways. This may allow patients to benefit from similar therapeutic approaches.

Surgery

Surgery in hidradenitis patients is used to drain larger abscesses that do not drain spontaneously and cause significant discomfort and pain. In addition to removing purulent material, the skin and structures involved in abscess formation are excised, particularly when lesions are extensive and tend to recur in the same location. These interventions are also used to repair fistulas and/or improve the scars left by more severe lesions.

Is hidradenitis suppurativa contagious?

No. Although the characteristic abscesses and nodules may become infected, hidradenitis is not an infectious disease and therefore cannot be transmitted to other people.

Is familial hidradenitis always inherited?

No. It is true that familial hidradenitis suppurativa is influenced by genetic factors. However, this means that direct descendants of affected patients have a higher probability of developing the condition, not that they will necessarily do so.

Does hidradenitis suppurativa worsen or improve during pregnancy?

Hormonal profile has a decisive influence on the course of hidradenitis suppurativa, so it is common to wonder what will happen during pregnancy. In general terms, and according to the available scientific evidence, hidradenitis suppurativa improves in a significant proportion of pregnant patients, and many affected women experience no changes.

Research also shows that pregnant patients whose hidradenitis worsens tend to have greater weight gain, more occlusion in skin folds and increased friction from clothing. In addition, increased adipose tissue contributes to worsening inflammatory markers, which in turn aggravates hidradenitis.

Finally, there appears to be a higher prevalence of pregnancy-related conditions in patients with hidradenitis suppurativa, such as gestational diabetes or pre-eclampsia (high blood pressure during pregnancy).

Can I breastfeed if I have hidradenitis suppurativa?

Patients with hidradenitis localised on the breasts may be forced to stop breastfeeding, depending on the severity of their lesions. However, they should consult a dermatologist specialising in hidradenitis to assess possible treatments and alternatives that may allow breastfeeding if the mother wishes.

Is there a diet that cures hidradenitis?

Some research has explored the relationship between certain foods or nutrients and hidradenitis suppurativa. The influence of dairy products, sugars and simple carbohydrates, gluten, wheat, brewer’s yeast, etc. has been studied, but conclusions are contradictory and evidence is not sufficiently robust, as studies often involve small numbers of patients or have methodological limitations.

For this reason, hidradenitis specialists support a generally healthy diet that helps maintain weight (or reduce it if necessary) and do not recommend adding or eliminating any specific food to improve the course of this condition. Likewise, they do not propose any specific diet (ketogenic, paleo, gluten-free, etc.) for hidradenitis patients, as there is currently no scientific evidence supporting their effectiveness.

Is there any vitamin supplement that improves hidradenitis?

Almost all chronic inflammatory diseases (including hidradenitis) are associated with vitamin D deficiency. However, there is no evidence that hidradenitis suppurativa improves by increasing vitamin D intake through diet or supplementation.

Some hidradenitis specialists prescribe zinc gluconate to selected patients, as some studies have found an association between this condition and zinc deficiency. However, given that the evidence is very limited, this is used as an adjuvant measure and never as a primary treatment line.

Can I use alternative therapies or natural products to improve my hidradenitis?

At present, there is no scientific evidence supporting the use of herbal preparations (tea tree oil, aloe vera, Chinese herbs, etc.), homeopathic products or alternative therapies (acupuncture, reiki, etc.) to cure or improve the course of hidradenitis suppurativa.

As described, hidradenitis suppurativa is a chronic disease: it has treatment, but currently no cure. Patients therefore need to learn to live with the condition and adopt certain measures and recommendations to control it and minimise the impact on quality of life.

Consult a hidradenitis suppurativa specialist as early as possible

Hidradenitis suppurativa has a negative impact on both physical and mental health. Delayed diagnosis leads to worsening symptoms and sequelae, as well as a significant reduction in quality of life. Early diagnosis is therefore essential to start effective treatment, improve disease course and prevent the most severe complications.

Control weight and do not smoke

Smoking and increased fatty tissue associated with overweight and obesity are pro-inflammatory factors. This, in turn, promotes hidradenitis flare-ups and worsens prognosis. For this reason, one of the first recommendations patients receive is to adopt a healthy lifestyle with a balanced diet and physical activity to avoid weight gain, and to stop smoking if they have this harmful habit.

Avoid tight clothing and synthetic fabrics

Overly tight clothing increases friction and occlusion on the skin—two triggers for hidradenitis flare-ups. Likewise, synthetic fabrics or wool, which promote irritation, sweat accumulation and itching, are not ideal for hidradenitis patients. Patients should preferably choose linen, cotton or similar breathable fabrics.

Laser hair removal: ask your hidradenitis specialist

The dermatologist specialising in hidradenitis may recommend laser hair removal to eliminate the hair follicle where abscesses often form. This option can be very effective in patients who develop recurrent abscesses in the same area.

Avoid stress

Emotional stress and anxiety are not direct causes of hidradenitis suppurativa. However, as with other dermatological conditions such as rosacea, acne, atopic dermatitis or psoriasis, they can trigger flare-ups and worsen disease progression. For this reason, hidradenitis specialists recommend managing these factors as much as possible.

The content of this page has been prepared by the Communication Department and the Medical Team of Grupo Pedro Jaén, in line with our editorial commitment to ensuring the accuracy and up-to-date nature of the information provided.

References on hidradenitis suppurativa:

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7. Chu CB, Yang CC, Tsai SJ. Hidradenitis suppurativa: Disease pathophysiology and sex hormones. Chin J Physiol. 2021 Nov-Dec;64(6):257-265. doi: 10.4103/cjp.cjp_67_21. PMID: 34975118.

8. A. Goñi-Navarro, P. Mollá-Roig, S. de la Fuente-Meira, R. Campos Ródenas, Complejidad Bio-Psico-Social En Pacientes Con Hidradenitis Supurativa: Un Estudio Piloto De Psico-Dermatología,Actas Dermo-Sifiliográficas,2022,,ISSN 0001-7310, https://doi.org/10.1016/j.ad.2021.12.017.

9. Emily K. Kozera, Michelle A. Lowes, Jennifer L. Hsiao, John W. Frew,Clinical considerations in the management of hidradenitis suppurativa in women, International Journal of Women’s Dermatology,Volume 7, Issue 5, Part B,2021,Pages 664-671,ISSN 2352-6475, DOI: 10.1016/j.ijwd.2021.10.012.