Hidradenitis suppurativa, considered a severe form of acne, is a chronic disease of certain (apocrine) sweat glands in the underarm and groin areas that causes them to clog and become infected. This condition can be very painful and also can cause unpleasant body odor. Eventually, scars develop, hardening the areas. We don’t know for sure what causes hidradenitis suppurativa, but the condition tends to run in families, is more common among women than men, and occurs more frequently among African Americans.
For reasons no one understands, the disease is often seen among those with Crohn’s disease, irritable bowel syndrome, thyroid conditions (Graves disease or Hashimoto thyroiditis), Sjogren’s syndrome (an autoimmune disorder), those infected with the herpes simplex virus and people with Down syndrome. It also tends to occur more often among those who have had severe acne, those with frequently ingrown hairs and those who perspire excessively.
The first symptoms usually are one or more tender, red swellings in the groin or underarm. These swellings can enlarge and then open and begin to drain. Then, over a period of 10 days to a month, the area heals but with scarring. Because the condition is chronic, it can flare up repeatedly, often in response to stress. Personal hygiene has nothing to do with developing the condition in the first place or with the flare ups.
While there’s no cure for hidradenitis suppurativa, the following lifestyle changes can help bring it under control and reduce flare-ups:
- If possible, avoid exposure to heat in order to minimize sweating.
- Lose weight if you’re overweight. (Hidradenitis suppurativa isn’t caused by being overweight but is worsened by excess weight).
- Avoid tight clothing.
- Avoid underarm antiperspirant deodorants, which may contribute to clogging of the apocrine glands.
- Bathe daily using an antibacterial soap; some doctors recommend antibacterial lotion for controlling body odor.
You’re correct in saying that conventional medicine doesn’t have a remedy for this distressing condition. Topical antibiotics can help control infection and, sometimes, surgery is needed to drain infected areas or remove scarring. The drug Humira (adalimumab), used to treat a number of inflammatory conditions, was approved by the FDA in October 2018 for treatment of moderate to severe hidradenitis suppurativa in patients age 12 and older.
I would recommend trying a mind/body approach, such as hypnotherapy as well as consulting a practitioner of traditional Chinese medicine. Those methods might reduce flare-ups and help contain the disease.
Andrew Weil, M.D.
Ditte Marie Lindhardt Saunte et al, “Hidradenitis Suppurativa: Advances in Diagnosis and Treatment”, JAMA November 28, 2017, DOI: 10.1001./jama.2017.16691