Marina was 24 years old when she first noticed a painful lump under her arm. It hurt for a few days, made it uncomfortable to raise her arm, and then disappeared on its own. She didn't pay much attention to it: she thought it might be an ingrown hair or a "swollen gland" due to the heat. Weeks later, the lump returned. In the same place. And this time, it brought company: another nodule, a little further along, also painful. Over time, some of them even opened up and released a little discharge. It was only when the marks began to accumulate on her skin, and her routine turned into a cycle of "inflames, bothers, improves, returns", that Marina saw a dermatologist and heard, for the first time, the name of her condition: hidradenitis suppurativa.

"The data and clinical case cited in this article are fictional and are purely illustrative, serving to facilitate understanding of the topic addressed."

What is hidradenitis suppurativa?

Hidradenitis suppurativa is a chronic inflammatory skin disease. It usually appears after puberty and is more common in women. The preferred regions are those where the skin has folds and rubs against itself: armpits, under the breasts, groin, genital area and buttocks. It is no coincidence: these areas concentrate a specific type of gland, the apocrine sweat gland, and for a long time doctors believed the disease was an infection or inflammation of these glands.

Today the understanding has changed. Science indicates that the problem actually starts in the hair follicles in these regions, which become inflamed and trigger the entire process. The exact causes are still not fully understood, but hidradenitis is considered an autoinflammatory disease: the body mounts an exaggerated defence response, which ends up attacking the skin itself. There is also a family tendency (that is, there may be similar cases among relatives) and a known association with smoking and other health alterations.

How the disease manifests itself

The most characteristic symptom is nodules, popularly called "lumps", painful and inflamed, which can progress to opening and drainage of pus. The most frustrating part for those living with the disease is the pattern of recurrence: the same lesion can become inflamed, improve, and become inflamed again in the same place, several times. As time passes, new lesions appear next to old ones, and scars form over the older ones.

In addition to pain, the constant drainage of pus can cause unpleasant odour and stain clothing, which greatly impacts self-esteem and social life. Scars, when extensive, can even limit the movement of arms and thighs. In rare cases, very old and persistently inflamed lesions may, over the years, favour the development of malignant neoplasms, which reinforces the importance of ongoing medical monitoring.

Is there treatment?

Yes, and the options vary greatly depending on the severity of each case. A doctor may recommend, individually or in combination:

  • Topical treatments, such as antiseptics (for example, chlorhexidine), topical antibiotics and resorcinol, which help control inflammation and bacterial infections.
  • Systemic medications, including oral antibiotics, immunosuppressants and, in some cases, hormonal contraceptives or metformin, which aid in inflammatory control.
  • Corticosteroid injections applied directly to affected areas, to reduce inflammation and pain.
  • Laser, which helps reduce hair in the region and, as a result, decreases inflammation and the formation of new abscesses.
  • Surgery, reserved for severe or persistent cases, which may involve drainage of abscesses, removal of scar tissue or even the affected glands.
  • Biological therapies, such as TNF-alpha inhibitors and anti-interleukins, indicated for severe cases that do not respond well to other approaches.
  • Potent analgesics, when pain is very intense.

Alongside these treatments, some daily care habits make a real difference: keeping the area clean and dry, avoiding tight clothing that causes friction and, whenever possible, stopping smoking, since cigarettes are one of the factors that most worsen the condition. Follow-up with a dermatologist is essential to adjust the treatment plan to each person's reality.

Can it be prevented?

Some habits seem to make a difference in the frequency and intensity of flare-ups. Studies link hidradenitis suppurativa to obesity and smoking, and there are indications that a diet rich in carbohydrates, sugars and animal fat may also worsen the condition. Therefore, maintaining a healthy weight and not smoking are important measures. Avoiding tight clothing and excessive sweating in the most affected areas also helps. Some reports also suggest that permanent laser hair removal, precisely because it targets the hair follicle (the starting point of inflammation), may bring benefit.

Does hidradenitis suppurativa have a cure?

There is no definitive cure, but it is a manageable disease. With correct treatment, many people are able to significantly reduce the frequency and intensity of flare-ups.

Is it a contagious disease?

No. Despite involving pus and, sometimes, unpleasant odour, hidradenitis is not an infection that is transmitted from person to person.

Is it poor hygiene?

No. This is one of the biggest myths about the disease. The cause is linked to inflammation of the hair follicles and to genetic and immunological factors, not to lack of cleanliness.

Only women have hidradenitis suppurativa?

No, men can also develop the disease, but it is more frequent in women, especially after puberty.

Is surgery always necessary?

No. Surgery is usually indicated for more severe cases or those that do not respond to other treatments. Many patients achieve good control with medication and lifestyle changes alone.

Does smoking really worsen the disease?

Yes, smoking is among the factors most associated with worsening of hidradenitis suppurativa, and stopping smoking usually brings noticeable improvement.

Can it turn into cancer?

It is rare, but very old and persistently inflamed lesions may, in exceptional circumstances, favour the development of malignant tumours in the region. This reinforces the importance of regular medical monitoring.

This content is educational in nature and does not replace a medical consultation. Each case should be individually evaluated by a dermatologist, who can indicate the most appropriate diagnosis and treatment.

Dr. Rebeca Soares Andrade

CRM - GO 39335