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 think much of it: she thought it might be an ingrown hair or a "small swollen lymph node" from the heat. Weeks later, the lump returned. In the same place. And this time, it brought company: another nodule, a bit further along, also painful. Over time, some of them even opened and released a bit of 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 merely 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 region, and buttocks. It's 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 begins in the hair follicles of 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 defense response that ends up harming 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

The most characteristic symptom is nodules, popularly called "lumps," that are painful and inflamed and can progress to opening and pus drainage. The most frustrating part for those who live 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. Over time, new lesions appear next to the old ones, and scars form over the older ones.

Beyond pain, constant pus drainage can cause unpleasant odor and stain clothing, which significantly 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, favor the development of malignant neoplasms, which reinforces the importance of continuous medical follow-up.

Is there treatment?

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

  • Topical treatments, such as antiseptics (for example, chlorhexidine), locally applied 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 help control inflammation.
  • Corticosteroid injections applied directly to the affected areas to reduce inflammation and pain.
  • Laser, which helps reduce hair in the region and thus decreases inflammation and the formation of new abscesses.
  • Surgery, reserved for severe or persistent cases, which may involve abscess drainage, removal of scar tissue, or even removal of the affected glands.
  • Biologic 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 practices make a real difference: keeping the area clean and dry, avoiding tight clothing that causes friction, and whenever possible, quitting 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), can bring benefit.

Does hidradenitis suppurativa have a cure?

There is no definitive cure, but it is a controllable 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 odor, hidradenitis is not an infection that spreads from person to person.

Is it a lack of hygiene?

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

Do 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 just medication and lifestyle changes.

Does smoking really worsen the disease?

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

Can it turn into cancer?

It's rare, but very old and persistently inflamed lesions may, in exceptional situations, favor the development of malignant tumors in the region. This reinforces the importance of regular medical follow-up.

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