Hidradenitis suppurativa (HS), also known as acne inversa, is a follicular occlusion disorder that can be painful and frustrating for patients. In the past, treatment options were limited for this condition; however, recently, more effective treatments were approved by the FDA to treat HS. Dermatologist and surgeon David T. Harvey, MD, of Piedmont Healthcare, discusses the common questions his patients have about acne inversa. 1. Q: What is hidradenitis suppurativa? A: Acne inversa is characterized by boil-like lumps that form under the arms, groin, breast, and in other areas where sweat glands are located. These lumps can rupture, resulting in discharge, sinus tracking, and scarring. It can be a very painful disease for those who have it. 2. Q: How is HS treated? A: Treatment of HS depends on how severe it is. In mild HS, I’ll prescribe topical antibiotics such as clindamycin and benzoyl peroxide. Oral antibiotics such as doxycycline or anti-inflammatory medications like Dapsone are also considered first-line treatments. For more severe cases, a new biologic medicine, adalimumab (Humira), was recently approved by the FDA to treat the inflammatory component of HS. This medicine is a type of TNF inhibitor. TNF stands for Tumor Necrosis Factor, a chemical known to induce inflammation and aggravate skin conditions like HS. Medications like adalimumab block TNF and help to reduce the inflammation seen in HS. I’m excited about this treatment because it offers us something new to effectively help our patients. 3. Q: What can patients do at home to reduce symptoms of HS? A: There are a few things people can do to help relieve their symptoms and reduce disease progression. First, patients should wear loose-fitting clothing to avoid friction in the affected areas. They should also bathe with antibacterial soaps so they don’t get infections. Some of my colleagues even go so far as to recommend bleach baths that will kill all bacteria. As the lumps can be painful, over-the-counter pain relievers such as ibuprofen or naproxen (NSAIDs) can be useful to ease the pain and swelling of HS. 4. Q: What triggers HS flare-ups? A: We know one trigger is smoking, so if you smoke and have HS, talk to your primary care physician about strategies for quitting. Some of our female patients experience flare-ups of their HS with their menstrual cycle, so sometimes going on birth control can help to calm these monthly flare-ups. Obesity also plays a role with HS, because excess skin folds can rub against each other and cause painful lumps to form. Weight loss, along with exercise, is the best solution for that. 5. Q: What do you wish patients knew about HS? A: I think there’s new hope for treating HS. Although it’s a difficult condition to treat, I’m excited about new treatments like biologics that can help our patients get better control over their HS. I want the community to know we are doing some in-depth research for HS treatments in order to find solutions to combat this disease effectively.