Ask the Pharmacist

Q) I was recently diagnosed by a dermatologist with a skin condition called hidradenitis suppurativa (HS). I have never heard of this. What can you tell me about it?

A) For a virtually unknown medical condition, HS has been known about for a long time (it was first described in the medical literature in 1839) and is way more common than most would guess. It’s prevalence in the Canadian population is approximately 4 in 100 with the majority of those affected being female (who are three times more likely to have it than are males). Other risk factors include being of African descent, overweight, a smoker or having been previously diagnosed with one of the inflammatory bowel diseases such as ulcerative colitis.

It tends to first occur in young adults (i.e. teens to 20’s) but it is a progressive and chronic disorder so, like so many other skin conditions, you will likely be dealing with HS for life although most people find it eases and flares up periodically often for no apparent reason. Researchers are unsure as to what causes it to occur but it is likely a result of an inherited (i.e. genetic) predisposition along with hormonal and environmental factors. It does not appear to be caused by a lack of washing or the use personal hygiene products (such as deodorant) and it is not contagious.

The first sign that you may have this condition is the sudden development of a single painful bump in your skin that becomes inflamed. Some will notice a sensation of itchiness or discomfort in the area shortly before the bump first appears. It is believed that this bump occurs as a result of hair follicles in the area becoming blocked. It is not uncommon for a person to have multiple bumps in the same general area or in multiple places at once. These bumps are most commonly located in skin folds and in areas where we tend to have more body hair such as the armpits, groin or the area around the anus. It is also commonly found under the breasts. These bumps can last anywhere from days to months. If left untreated, these bumps can turn into odorous pockets of pus that can leak onto the surface of the skin. If the bumps are deep enough, they can leave scar tissue behind when they heal and if the condition goes unchallenged for a long period of time it can progress to tunnels under the skin or open wounds.

Treatment depends upon the severity of the condition but a necessary first step is to quit smoking for those that do and to drop a few pounds as friction and perspiration from excessive skin folds seems to exacerbate the situation. If the bumps have not progressed to pustules then the use of an antibacterial cleanser that uses chlorhexidine or benzoyl peroxide (both available without a prescription) can be quite effective in resolving them quicker than they would otherwise clear on their own. As well, most dermatologists recommend the application of a clean washcloth soaked in hot water (i.e. a hot compress) to be applied to the affected area for approximately 10 minutes several times a day.

Getting your vitamin D levels up to normal (a simple blood test can help you determine how much in the way of a supplement, if any, you need to add) can be beneficial and there is some evidence that taking zinc gluconate 90mg once a day might also be helpful.

Another good option for mild to moderate cases is the use of a prescription liquid containing the antibiotic clindamycin that is applied to the affected areas twice a day. It’s easy to apply to skin folds, has a drying effect and might help prevent new pustules from developing. All of these steps can keep your symptoms from getting worse and help minimize future outbreaks.

For more severe symptoms or if these steps fail to improve your skin there are a number of other options that may be tried as well. In females, oral contraceptives (otherwise known as birth control pills), the diabetic pill metformin or spironolactone (a pill that has been used for decades to lower blood pressure) can help normalize hormonal levels and provide real benefits. All three medications are usually very well tolerated. Should this not work, either gender can take antibiotics by mouth.

The best choice is a course of doxycycline for at least 12 weeks although it may be continued for a longer period of time in some cases. For more advanced cases there are a number of options that have the potential to improve the skin but also come with a greater risk for side effects. These include the biological drug Humira, a number of antibiotics such as dapsone, a cortisone shot that is injected right into the bumps, the oral retinoids acitretin or Accutane, the immune suppressant cyclosporine and finally there are surgical measures that can be performed such as the draining of any abscesses. L

ike all skin conditions, hidradenitis suppurativa is a long term issue that can really affect a person’s self esteem and quality of life. However, with early treatment, many can get a handle on this condition and thereby minimize future flare-ups and permanent skin disfigurations. For more information about this or any other health related issues, please contact your pharmacist.