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Hidradenitis suppurativa

Hidradenitis suppurativa (acne inversa) · Hidradenitis suppurativa (acne inversa)

What it is

Painful recurring abscesses and tunnels in the armpits, groin and under the breasts. Badly under-diagnosed.

Symptoms & signs

  • Recurrent painful lumps
  • discharging sinuses
  • scarring bands
  • flares with friction and heat

🚩 Get help if…

  • call 112 / 911 now High fever with a hot, rapidly spreading red area
  • see a doctor soon Painful lumps with fever or feeling very ill
  • see a doctor soon Lumps that keep coming back in the armpits, groin or under the breasts
  • see a doctor soon Pain or draining sores that stop you working or sleeping

Where it strikes

Medical treatment

  • Topical clindamycin
  • oral tetracyclines
  • adalimumab or secukinumab
  • deroofing or wide excision
  • hormonal therapy
  • bimekizumab (IL-17A and F blocker) — approved 2024 (EMA, FDA)

Natural & lifestyle

  • Stop smoking (the strongest modifiable factor)
  • weight loss
  • loose clothing
  • antiseptic washes
  • zinc supplementation

Emerging & experimental

  • JAK inhibitors
  • laser hair removal as prevention

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Metformin — small studies reduced flares early / small studies
  • Dairy-free and brewer's-yeast-free diets — small uncontrolled studies early / small studies
  • Turmeric — small studies early / small studies

ICD codes