Center for Hidradenitis Suppurativa

Hidradenitis suppurativa (HS), also known as acne inversa (AI), is a chronic inflammatory disease of the hair roots that tends to particularly affect the following regions: armpits, groin, anal and genital regions, abdominal folds and folds under the female breast. The two terms above are used interchangeably in German. However, the term hidradenitis suppurativa (HS) is more widely used internationally. It is important to avoid confusion with the classic “acne” of adolescence, as these are completely different clinical conditions. The term HS has been used throughout this article for clarity.

The first skin changes often appear after puberty, and the condition is usually extremely painful. In the absence of treatment, HS may lead to severe destruction of the skin, with significant scarring and reduced mobility, which may significantly reduce patient quality of life.

In the following article, we would like to provide you with an overview of the symptoms, causes and treatment of HS.

First, patients develop palpable lumps and swellings, which are typically very painful. Scarring, suppuration and fistulae are more predominant in the later stages. These changes extend deep into the surrounding tissue, and the resulting growths may drain spontaneously to release pus, blood or a foul-smelling secretion. HS typically follows a relapsing and remitting course (periods of freedom from symptoms, followed by flare-ups). The number and duration of flare-ups may vary greatly.

The pain is often the most troublesome feature for patients. However, the drainage from growths, i.e. the discharge of blood and pus, is also very stressful. Severe exhaustion, also known as fatigue, is also often reported.

The disease is believed to be caused by inflammation of the hair roots. However, the specific underlying causes remain unknown. After a hair follicle has ruptured, a potent inflammatory reaction is triggered in the dermis. This process involves several different inflammatory messenger substances, known as cytokines.

Doctors suspect that there are risk factors that worsen the course of the disease. Among others, these specifically include smoking and obesity, as well as mechanical friction (e.g. from wet shaving and wearing tight clothing) and increased production of sweat. Stress, psychological stress and hormonal disorders may all affect the severity of the condition. Some patients have reported other cases of HS in their family, suggesting that some patients may have a genetic predisposition. Other illnesses that are frequently associated with HS, known as comorbidities, include metabolic syndrome, chronic inflammatory bowel diseases, rheumatic diseases, depression and cardiovascular diseases.

The treatment depends on the severity of the disease. General measures form the foundation of treatment, and should be employed regardless of the severity:

• Elimination of existing risk and trigger factors (smoking cessation, weight and stress reduction)
• Keeping affected areas dry (e.g. insertion of linen pads)
• Wearing loose clothing to avoid mechanical irritation
• Avoiding wet shaving
• Consistent personal hygiene with daily disinfection of the affected areas and adequate skin care

The measures mentioned here are merely supportive and usually not sufficiently effective on their own. They should still be carried out, in addition to further treatment.

If the condition is mild, a therapeutic trial of antibiotic or disinfectant agents for skin application may be attempted. This is also known as topical therapy. Additional oral treatment with high-dose zinc may also be considered in mild cases.

Antibiotic treatment for this condition is well-established, and antibiotics are typically administered to patients with HS for 10–12 weeks. Antibiotics may have different active substances and may be combined if needed.

If treatment with antibiotics does not result in improvement, then patients may be started on immunomodulating therapy. This is administered into the subcutaneous tissue as injections. Three different biologics are currently authorised for moderate to severe HS. There are also a large number of new medications in clinical development. Our Study Centre, which specialises in HS, will be happy to inform you whether a relevant study is suitable for you.

Surgical treatment also plays an important role for HS alongside pharmaceutical treatment. Acute, painful abscesses may require surgical treatment. The primary objective in such cases is short-term pain relief. Surgical removal is still the first choice for treating irreversible tissue destruction, which is characterised by fistula tracts, scar extrusions and/or contractures. The size of the surgical wounds usually depends on the severity and extent of the HS.

The forms of treatment mentioned above are often used in combination, especially for more severe forms of HS, but should always be carried out in consultation with your attending doctor after you have undergone periodic clinical examination. The therapeutic objective is determined collaboratively with the patient and a personalised treatment plan is created. Treatment often requires a great deal of patience, as this is a chronic, relapsing disease.

As one of the largest centres for HS in Germany and Europe, we are intensively involved in clinical research and recruit for several clinical studies. This enables us to offer our patients modern, alternative medications as part of a study. You can find a list of the studies here

The team at our Dermatology Study Centre will be happy to answer any of your questions.

Acute or chronic illnesses may lead to considerable changes in everyday life for affected patients. Physical, psychological, social, professional and financial problems pose major challenges.

A central aim of discharge management and social services is to ensure the success of hospital treatment. This requires early clarification of aftercare needs, personal, family and social resources, as well as the medical situation. We work with the patient to develop a sustainable concept that is agreed with the parties involved in the treatment process and the cost bearers. This includes the following focus items:

• A nursing service for treatment care (e.g. wound care)
• Domestic help via health insurance
• Arrangement of wound management

• Wage replacement benefits, e.g. sick pay
• Copayment and copayment waivers
• Basic income in accordance with the German Social Code (SGB) II/XII
• Reduction in earning capacity
• Loss compensation in accordance with SGB IX (“severe disability”)