Hidradenitis suppurativa: skin condition with inflammation

Hidradenitis suppurativa is a chronic inflammation of the hair follicles and it mainly occurs in the armpits and groin. It occurs when the opening of the hair follicle becomes blocked, causing skin cells that you normally shed to accumulate in the hair follicles. A cavity is created in which bacteria accumulate and if it bursts, the inflammatory fluid flows out. It smells unpleasant, is unsightly and is not pleasant for the patient. The affected area is often painful and an abscess may develop. What causes this annoying condition and how can it be treated?

What hidradenitis suppurativa entails

Inflammation of the hair follicles, also known by the medical term hidradenitis suppurativa , or acne inversa or acne ectopica , is a chronic inflammation of the hair follicles. It mainly occurs in the armpit and groin, but can also occur in the genitals, buttocks or under the breasts. It is a purulent inflammation, where the inflammation is in the hair follicles. The opening of the hair follicle becomes blocked. The inside of the hair follicle is lined with skin cells that normally disappear in the form of dander after they die. As these accumulate and new skin cells continue to divide, a build-up consists of skin flakes, keratin, sebum, living and dead skin cells and bacteria. The pus that forms looks for a way out and the hook sac will eventually burst, causing the mess to come out. It is very bothersome for the patient and he may feel ashamed of it. It is very unsightly and can smell unpleasant.

The gradient

Cavities and passageways develop in the affected area. Bacteria can multiply here, causing the inflammation to spread. If it is not possible to break out through the skin, tunnels will be created in the tissue (fistulas) and in this way a network of tunnels can be created under the skin. Tunnel-shaped connections are created between the inflamed cavities and the skin on the outside. Abscesses develop again and the fistulas expand. Scar tissue forms and the inflammation becomes more difficult to combat. A characteristic of this skin condition is that it always returns in the same place.


Heredity plays a major role in developing this condition. Furthermore, excessive sweating and tight clothing can contribute to aggravation of the complaints. For example, smokers have more black spots in their skin (blackheads), more clogged sebaceous glands and hair follicles than non-smokers. It has not been proven that smoking plays a role, but it is recommended that you stop smoking if you suffer from hidradenitis suppurativa. It is not known why some people get it and others do not. It is not known whether quitting smoking positively influences the course of the complaints.

Risk groups

Although it sometimes resembles acne (pimples), this condition occurs during or after puberty. You often see it develop between the ages of 20 and 25. It is slightly more common in women than in men. About 1 percent of adults in our country suffer from this. It seems that it has to do with being overweight. This could be due to the fact that overweight people have more skin folds. However, the clearest link remains with cigarette smoking.


The GP can often make a diagnosis based on the complaints and symptoms. If you are referred to a dermatologist, he can investigate this further. Sometimes a piece of tissue is taken ( biopsy ) under local anesthesia and this will be examined microscopically.


This condition is difficult to treat. The skin can be treated locally with a cream containing resorcin. This ensures that new inflammations are prevented or inhibited. The affected skin can be disinfected for several weeks with betadine-iodine. Taking antibiotics for a while can help calm the condition. Sometimes it is temporary in nature. An active inflammation can be treated in the early stages with an injection of triamcinolone . If an abscess has formed, it can be treated by cutting it open to allow the pus to drain and installing drainage to prevent a new abscess. Scars increase the chance of recurrence. There are also medicines ( TNF-alpha blocker ) that tackle the disease at the source.
There is no treatment that can definitively solve the problem. Even if a treatment seems successful, it can always come back. Poor hygiene can worsen the symptoms, so keep it clean. For example, you can use iodine soap in the shower. An external treatment with an antibiotic in a lotion is sometimes also done, but this generally does not help enough when used as the only treatment. If you stop smoking or lose weight if you are overweight, this may benefit you. Women are often treated with an anti-male sex hormone in the form of a contraceptive pill containing the drug cyproterone acetate

Surgical treatment

If the condition becomes severe, with very painful inflammation, an incision may be made in the abscess. This is a symptom treatment. If surgery is required to address the cause, a lot of tissue will often have to be removed. If the wound is too large to close, a skin graft will need to be performed. This is a major operation, which will result in scar tissue. Even this procedure offers no guarantees that you will be cured. It can come back again, even in a different place.

Laser treatment

The laser (CO2 laser) is sometimes used as a treatment in which inflamed tissue is removed through evaporation. This is also a major operation, which sometimes must be performed under anesthesia. The treatment often needs to be repeated. It takes at least four weeks for the skin to heal again and scars may also form.

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