Medical dermatology · Skin conditions
Hidradenitis suppurativa: nodules and abscesses in the underarms and groin
Hidradenitis suppurativa is a chronic inflammatory disease of the follicles that causes painful nodules, abscesses that drain fluid and, over time, tunnels and scars under the skin, mainly in the underarms, groin, under the breasts and on the buttocks. It is not contagious or caused by poor hygiene. Early diagnosis, supported by dermatologic ultrasound, and appropriate treatment control the disease and prevent progression. At Yamagata Dermatologia, in Ipanema, Rio de Janeiro, diagnosis and treatment are carried out by dermatologists.
Symptoms and how to recognize it
Hidradenitis usually begins after puberty, with nodules that keep coming back in the same areas and are mistaken for boils.
- Painful nodules that look like boils and keep coming back in the same place
- Abscesses that burst and drain fluid, sometimes with a bad smell
- Tunnels (sinus tracts) under the skin connecting the lesions
- Cord-like scars in the affected areas
- Common areas: underarms, groin, under the breasts, buttocks and genital area
Causes and risk factors
The disease begins with blockage and inflammation of the follicles in skin folds. The rupture of the follicle under the skin triggers intense inflammation, which forms abscesses and tunnels. Genetic, hormonal and immune factors are involved. Smoking, obesity and friction are the main aggravating factors.
Diagnosis
Diagnosis is clinical, based on the type of lesion, its location and the recurrence of flares. Dermatologic ultrasound identifies lesions below the surface, such as tunnels and fluid collections, and helps classify severity and monitor the response to treatment.
Treatments
Treatment is defined according to severity and usually combines medications and procedures.
- Topical and oral medicationsAntibiotics and other medications, according to severity.
- Biologic therapyModerate to severe hidradenitis.
- Intralesional injectionIsolated inflamed nodules.
- Dermatologic surgeryDrainage or removal of tunnels and affected areas, when indicated.
Living with it and prevention
- Quit smoking and aim for a healthy weight.
- Wear loose cotton clothing, avoiding friction on the affected areas.
- Do not squeeze the lesions.
- Keep up ongoing treatment, even between flares.
When to see a dermatologist
See a dermatologist when painful nodules keep appearing in the underarms, groin or buttocks. Early treatment prevents the formation of tunnels and scars.
All procedures are recommended and performed after an individual medical evaluation. Results vary from person to person.
Questions
Frequently asked questions
Is hidradenitis caused by poor hygiene?
No. Hidradenitis is an inflammatory disease linked to genetic, hormonal and immune factors, and has nothing to do with poor hygiene.
Is hidradenitis contagious?
No. The disease is not contagious.
Why have an ultrasound?
Dermatologic ultrasound shows nodules, fluid collections and tunnels under the skin that are not always visible on clinical examination. It helps with diagnosis, severity classification and treatment follow-up.
What makes hidradenitis worse?
Smoking, excess weight, friction, tight clothing and heat worsen the disease. Quitting smoking and managing weight are part of the treatment.
Team
Medical team
See also