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Understanding Hidradenitis Suppurativa: Myths and Realities

July 18, 2023

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Clearing Up Common Misconceptions Surrounding This Chronic Skin Condition

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by painful nodules, abscesses, and sinus tracts in areas of the body where skin rubs against skin, such as the armpits and groin (Zouboulis et al., 2015). Many myths surround HS, leading to confusion and delayed diagnosis. This article aims to clarify these misconceptions with insights from experts and evidence from authentic Ayurvedic sources and modern research.

Understanding Hidradenitis Suppurativa: Myths and Realities

What Exactly Happens With HS?

HS affects approximately 1% of the population (Revuz, 2009). It typically manifests in adults during their teens, twenties, or thirties and can worsen if left untreated (von der Werth & Williams, 2000). HS predominantly affects intertriginous areas—the armpits, groin, under the breasts, and buttocks—and tends to recur in the same locations (Alikhan et al., 2009). Initially, it may resemble severe acne or inflamed hair follicles. As the disease progresses, nodules can develop into abscesses filled with pus, leading to chronic tunneling wounds and deep scars (Zouboulis et al., 2019).

“It’s amazing how many patients suffer for a long time and are unaware of their diagnosis,” says Dr. Adil, Lead Ayurveda Skin Specialist at EliteAyurveda.

How Do Doctors Diagnose HS?

There is no specific laboratory test for HS. Diagnosis is primarily clinical, based on the characteristic lesions, their location, and recurrence (Jemec, 2012). Dermatologists look for “draining wounds in natural folds in the body such as the armpits, groin, around the anus, under the breasts, and beneath the abdomen,” according to Dr. Adil. In milder cases, patients may have only one painful nodule. As HS progresses, clusters of pus-filled nodules may develop. Due to its disfiguring appearance, HS carries a stigma, leading to various myths about its nature and origin (von der Werth & Jemec, 2001).

Common Myths and Realities

Myth: Hidradenitis Suppurativa Is Contagious

Some believe HS is contagious due to its resemblance to infectious skin conditions like measles or chickenpox. However, HS is not communicable (Sellheyer & Krahl, 2005). While the exact etiology remains unclear, genetic predisposition and immune system dysregulation play significant roles (Gao et al., 2016). You cannot contract HS through contact with an affected person’s skin or belongings.

Myth: Sexual Transmission of Hidradenitis Suppurativa

Due to its occurrence in the groin area, HS is often mistaken for a sexually transmitted infection (STI). Unlike STIs such as herpes, HS is not transmitted through sexual activity or bodily fluids (Dessinioti & Katsambas, 2014). “Contact with bodily fluids will not cause transmission,” affirms Dr. Adil.

Myth: Hidradenitis Suppurativa Is Just Bad Acne

HS and acne may appear similar but are distinct conditions. Acne typically affects the face, neck, back, and chest, whereas HS occurs in intertriginous areas (Sartorius et al., 2009). HS lesions are more prone to forming chronic sinus tracts that drain continuously or recur over months, unlike acne lesions that generally heal within weeks (Zouboulis et al., 2019). Misdiagnosis can lead to ineffective treatments and prolonged suffering.

Myth: Poor Hygiene Contributes to HS

A common misconception is that inadequate hygiene leads to HS, especially as the disease progresses and lesions emit foul-smelling pus. HS is caused by an overactive immune response and is not related to cleanliness (Scheinfeld, 2013). Risk factors include genetics, obesity, and smoking, but not personal hygiene (Shahi et al., 2014). “It’s a common misconception that not being clean causes HS,” notes Dr. Adil.

Myth: Hidradenitis Suppurativa Only Affects Women

While HS is more common in women—affecting them nearly three times more than men—it is not exclusive to females (Schrader et al., 2014). Men can also develop HS, often with a later onset. Racial factors also influence prevalence; individuals of African descent are more susceptible (Garg et al., 2017). Gynecologists may detect HS during routine exams, but it is not a gender-specific disease.

Myth: You Can’t Treat HS

This misconception may stem from misdiagnosis and ineffective treatments. While HS is a chronic condition, various treatments can manage symptoms, reduce inflammation, and improve quality of life (Ingram, 2017). Options include medications, surgical interventions, and lifestyle modifications (Alikhan et al., 2019). “We’re in a time where we have more treatment options than ever to treat the disease,” says Dr. Adil. “The earlier we can diagnose people, the better off they’ll be.”

Fact: You Can Get Help

It’s easy to become discouraged, especially if you’ve tried and failed numerous times to improve your symptoms before realizing you have HS. “It is a disease that has an incredible burden on patients’ overall quality of life, including daily activities like walking, wearing sleeveless clothes, sexual activity, and sports,” Dr. Adil adds. However, there are several things you may do to improve and reduce the frequency of your symptoms. Seeing a specialist as soon as possible is critical, as treatment is most successful before HS worsens and becomes more severe (Patel et al., 2017). Most essential, do not struggle alone.

Our Outlook

According to Ayurveda, HS may be correlated with conditions caused by the imbalance of Kapha and Pitta doshas (Lad, 2002). An imbalance in Agni (digestive fire) can lead to the vitiation of Kapha, slowing metabolism and causing the accumulation of toxins (Ama) (Dash & Sharma, 2005). These toxins may obstruct bodily channels (Srotas), leading to the formation of painful sores in areas like the groin, buttocks, thighs, and armpits.

In Ayurveda, the treatment aims to restore the body’s natural equilibrium through detoxification (Shodhana) and pacification (Shamana) therapies (Sharma, 2005). Herbal remedies, dietary modifications, and lifestyle changes are prescribed based on individual Prakruti (constitution) and Vikruti (current state of imbalance) analyses (Murthy, 2004).

Conclusion

HS is a complex, chronic skin condition surrounded by misconceptions that can delay effective treatment. Understanding the myths and realities is crucial for early diagnosis and management. Both modern medicine and Ayurveda offer approaches to manage HS symptoms and improve patients’ quality of life. Consulting healthcare professionals familiar with HS is essential for personalized care.

References

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Medically reviewed by Dr. Adil Moulanchikkal, Lead Ayurveda Specialist at EliteAyurveda Clinics. With over 15 years of experience in treating neurological, skin, and autoimmune diseases.

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