June marks hidradenitis suppurativa (HS) awareness month, an important opportunity to improve understanding of HS and highlight practical ways to help manage this complex condition.
For many people living with HS, the journey to diagnosis can be long and frustrating. Research suggests that symptoms may be present for an average of 10 years before a diagnosis is made. By increasing awareness, we can help people recognise the signs and access appropriate treatment earlier.
What is hidradenitis suppurativa?
Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the hair follicle. It typically causes recurrent, painful nodules (swelling beneath the skin), boils (tender lumps around a hair follicle) and abscesses (painful collection of pus under the skin), in areas where skin rubs together, such as the armpits, groin, buttocks and under the breasts.
Although HS affects an estimated 1–4% of the population, many people have never heard of it until they receive a diagnosis.
HS can have a significant impact on physical health, emotional wellbeing, sleep, work, relationships, and day-to-day activities.
What causes it?
The exact cause of HS remains unclear. However, research into the condition is advancing rapidly, helping to improve understanding and develop new treatment options.
HS is thought to happen due to blockage of the hair follicles on the skin causing the follicle to swell and eventually burst. The immune system reacts to this, causing the surrounding area to become inflamed.
Several factors appear to influence the development of HS, including:
- Genetics and family history.
- Hormones, some patients may notice flares related to their menstrual periods.
- An over-active immune response.
- Bacteria which normally live on everyone’s skin may become trapped in the blocked hair follicle leading to inflammation.
- Cigarette smoking.
- Living with obesity.
Importantly, HS is not caused by poor hygiene and is not contagious.
Practical ways to support HS management
Although there is currently no cure for HS, many people find that a combination of treatments and self-management strategies helps reduce symptoms and improve quality of life.
Here are a few practical tips that may help:
- Seek medical advice early: earlier diagnosis can help individuals access appropriate treatment sooner and reduce the risk of disease progression.
- Wound care matters: managing wounds and dressings can be one of the most challenging aspects of living with HS. It can be time-consuming, costly, and emotionally draining.
Good wound care is important to minimise further skin trauma. Where possible, adhesive tapes should be avoided as they may damage already sensitive skin.
Practical wound care guidance is available through the Irish Skin Foundation, including:
Of note, amongst the dressings available, there are some specialised products such as PolyMem dressings and HidraWear garments, which can help keep dressings securely in place reducing friction, are available through the medical card or drug payment scheme. Patients can discuss what best suits their needs with their healthcare team.
- Helpful strategies to reduce friction/skin trauma that may exacerbate HS include:
- Wearing loose-fitting cotton clothing.
- Minimising excess heat and sweating where possible.
- Avoiding excessive scrubbing or aggressive cleansing of affected areas.
- Simple changes to improve sleep include:
- Keeping the bedroom cool.
- Considering a mattress topper that helps regulate heat and improve comfort.
- Smoking cessation: HS is more common in smokers and therefore quitting may improve symptoms. The HSE offers a smoking cessation service where people may create a quitting plan via the HSE Health App, on the website itself or in-person in their local “stop smoking” clinics. Further information can be found on the HSE website.
- Maintain a healthy weight: this may also help reduce HS symptoms.
- Hair removal considerations: shaving and waxing may occasionally irritate the skin or cause minor trauma that can trigger symptoms.
Some individuals may wish to consider laser hair removal, which targets the hair follicle, and may be beneficial. However, this can be expensive and may not be suitable or effective for everyone. Patients should discuss with their healthcare professional and also ensure their provider is aware they have HS before treatment.
- Choosing a deodorant: deodorants do not cause HS. However, some products may clog pores or irritate sensitive skin.
People with HS may wish to choose non-aluminium, paraffin-free products and discontinue any product that causes irritation.
- Antiseptic washes: although research evidence is limited, some people with HS report antiseptic washes to be helpful.
Raising awareness, improving lives
HS is a complex, chronic condition that can have a significant impact on peoples’ lives. Raising awareness can help reduce stigma, support earlier diagnosis, and improve access to care.
Living with HS can be challenging, but support is available. In addition to seeking advice from healthcare professionals, many people find comfort in connecting with others who understand their experiences such as through the Hidradenitis Suppurativa Ireland Facebook Support Group.
As we highlight HS this June, you may wish to take a moment to learn about HS and start a conversation.
If you need free support or guidance managing a skin condition, contact the Ask-a-Nurse Helpline.
