Hidradenitis Suppurativa (HS)

Hidradenitis suppurativa (pronounced HI-drah-duh-NI-tihs SUHP-er-uh-TEE-vuh) is a chronic (long-term) skin condition that causes painful bumps to come and go on parts of the body where the skin rubs together. It most often appears in the armpits, the groin area and under the breasts. One in every 100 people is estimated to have hidradenitis suppurativa (HS) and it tends to be more common in girls and women.

In HS, pressure or rubbing on the skin causes hair follicles, the tiny holes on your child's skin that hair grows out of, to become clogged with a protein called keratin that makes the skin, hair, and nails. Once clogged, the hair follicles can burst and cause the body’s immune system to respond. The immune system’s response causes the area to make a painful bump that is full of fluid.

We do not fully understand why some children get HS and others don’t, but doctors believe it is related to the immune system, hormones and things in the environment that make a person’s skin more likely to form bumps. HS tends to run in families and is more likely to occur in people who are overweight, have diabetes or smoke.

If your child has this skin condition, you may notice one or more painful bumps and sores (abscesses) under the skin. These bumps come and go, and at times become red and drain pus, a yellow-white liquid. Sometimes the bumps also itch or burn. In severe cases, multiple bumps connect with one another and form narrow channels under the skin called sinus tracts. Both the bumps and sinus tracts leave scars on the skin. We understand that this condition is painful for your child and affects their everyday life. We are here to help.

Children’s Hospital of Philadelphia (CHOP)’s team of pediatric dermatologists will diagnose your child’s hidradenitis suppurativa by looking at their skin for boils and bumps in certain places that are common to this condition. Sometimes, our doctors may order lab tests of the fluid from the bumps to rule out other diseases or conditions.

Right now, there is no way to completely get rid of HS, but our team of dermatologists is dedicated to helping your child feel more comfortable in their skin. Fortunately, there are treatments that can help the discomfort of existing bumps and other treatments that stop new bumps from happening. Treatment is most successful when it is started early. Most patients need a combination of treatments to achieve control.

Treatment for hidradenitis suppurativa 

Treatment for your child’s hidradenitis suppurativa can include:

• Lifestyle changes. Symptoms may improve when shaving, tight clothing and other irritants are avoided. Stopping smoking and weight loss may also be helpful for some.
• Antimicrobial washes. HS is not a result of not being clean, but special washes can be used to decrease the chances of bumps forming.
• Antibiotics. HS is not due to an infection, but antibiotics can be used for their ability to decrease inflammation. For mild cases, an antibiotic applied to your child’s skin may help. For more severe cases, an oral antibiotic may be needed.
• Hormonal medicines. Topical and oral medications can be used to help normalize the balance of hormones in your child’s body.
• Other oral medicines. Some cases may require additional classes of medications including retinoids (vitamin A-based products used on skin) and corticosteroids (also called steroids).
• Pain medicines. Over-the-counter pain medicines can ease pain and limit inflammation. Your child may need stronger medicines for a severe case.
• Injected medicines. Injectable and IV medicines can be used if your child has more severe symptoms. They work to limit the body’s ability to become inflamed.
• Procedures. A steroid may be injected into the bump to ease pain. In certain cases, bumps can be drained with special tools. For severe cases, your doctor may perform surgery to remove the area of affected skin or use a laser to destroy the affected area.

Hidradenitis suppurativa at school

It can be difficult for children with HS to go to school. Sharing more about your child’s condition with teachers may be helpful. Our care team will be happy to give you a sample letter that you can provide to teachers.

You may also consider partnering with your child’s school to create a 504 Plan. A 504 Plan is a formal agreement between a family and the school. It ensures that children with medical or psychiatric conditions have whatever they need to receive their education. This might include school nurse visits, missing gym class, bathroom breaks or a different school uniform. Learn more about 504 Plans.

Make an emergency kit

An emergency kit can be made to allow your child to have easy access to emergency supplies when they are away from home. An emergency kit may contain:

• Instructions for wound care
• Dressing and wound care supplies
  • Bandages
  • Tape
  • Scissors
• Chlorhexidine wipes (disposable antiseptic wipes to help kill germs on the skin)
• Instant hot/cold packs
• Undergarments
• Change of clothes
• Encouragement cards

Coping with hidradenitis suppurativa

While living with HS, your child might experience additional complications like:

• Depression
• Anxiety
• Scarring of the skin
• Skin cancer – it’s important to have regular dermatology visits so we can monitor for this.

HS can make it hard for your child to do normal daily activities. It is a condition that can be especially challenging for children and teens. The pain and scars from HS can cause your child to feel alone, worried, sad, or scared. If your child is experiencing these symptoms, you are not alone. Our Dermatology team is here to support you.

Please visit our HS resources list or contact us by phone at 215-590-2169 for ways to help your child cope with their feelings.