Treating Hidradenitis Suppurativa of the Breasts


Marijke Vroomen Durning, RN

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Hidradenitis suppurtiva of the breasts is a chronic inflammatory disease that can be painful and very uncomfortable.

There’s no cure, but treatment may help bring the condition under control and help you get relief.

What is hidradenitis suppurtiva of the breasts?

People with hidradenitis suppurtiva, also called acne inversa, develop red, inflamed, painful bumps or lesions anywhere on the body, but most often near sweat glands and where areas of skin rub together. Women may find the lesions under the breasts up to the axilla (underarm), as well as on the breasts themselves.

Hidradenitis suppurtiva isn’t contagious, but you may think it’s unsightly if the rash and bumps are visible to others. The area can look very red and angry.

What causes hidradenitis suppurtiva of the breasts?

The bumps from hidradenitis suppurtiva are caused when hair follicles become blocked and inflamed, similar to how facial acne forms. However, unlike facial acne, the bumps with hidradenitis suppurtiva remain below the skin and push the skin up.

The condition affects women three times more often than men. It’s possible that hormones and genetics may be involved, but doctors don’t know for sure. People who may be at higher risk of hidradenitis suppurtiva include those who:

  • Are women between 20 and 29 years old

  • Are overweight or obese

  • Smoke

  • Have a family history of hidradenitis suppurtiva

  • Have other conditions or diseases, such as arthritis, severe acne and diabetes

Hidradenitis suppurtiva of the breasts occurs most often among women with large breasts, although it can begin as early as puberty, before the breasts are fully developed.

Are there any complications associated with hidradenitis suppurtiva?

The red, inflamed bumps from hidradenitis suppurtiva can be painful, particularly if your breasts or clothing are rubbing against them. You may also find that the appearance changes. Sometimes you may have just a few bumps, while other times, there may be many red, raised areas under your breast or on the breast itself. You may also see:

  • Bumps break open and leak a foul-smelling fluid

  • Bumps get infected

  • Scars where the bumps were

  • Tunnels form underneath the skin

In rare cases, hidradenitis suppurtiva may lead to squamous cell skin cancer.

How is hidradenitis suppurtiva treated?

How hidradenitis suppurtiva is treated depends on how severe it is and how much it bothers you. If you are overweight, you may be counseled to lose some weight, in order to reduce the amount of breast tissue rubbing against the affected area. If you have a mild case, other suggestions may include:

  • Taking pain medications if needed

  • Cleaning the area with antiseptic soap

  • Keeping the area as dry as possible

  • Applying antiperspirants

  • Applying warm compresses

  • Avoiding underwire and tight bras

  • Quitting smoking

If your case is considered to be moderate, your doctor may prescribe:

  • Topical creams similar to vitamin A, called retinoids

  • Acitretin (Soriatane) or isotretinoin (Accutane) oral retinoids used for severe acne

  • Non-steroidal anti-inflammatory medications

  • Antibiotics

  • Corticosteroid injections directly into the bumps

  • Oral contraceptives, for the hormones

And if your case is severe, you may need:

  • Biologic therapies such as adalimumab or infliximab, which are TNF inhibitors  

  • Immunosuppressant medications like cyclosporine

  • Surgery to open and drain the bumps, to clear them of pus and infection

  • Radiotherapy

Hidradenitis suppurativa of the breasts can cause some women to want to isolate themselves, staying home and not participating in social activities. Aside from the pain the bumps cause, women may feel self-conscious if the bumps are visible. If you have hidradenitis suppurativa, speak with your doctor to see what you can do to help reduce the number and severity of the bumps, and so you feel more comfortable overall.

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PHYSICIAN CONTRIBUTOR cotton-pads-and-peroxide

How Doctors Approach Treatment for Hidradenitis Suppurativa

The goals of treatment are to clear and prevent breakouts, and get rid of scars.
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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: May 11, 2016

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Medical References

  1. Hidradenitis Suppurativa: A Treatment Challenge. American Academy of Family Physicians.
  2. Breast Disorders and Screening.
  3. Hidradenitis suppurtiva. American Academy of Dermatology.
  4. Hidradenitis suppurtiva. Mayo Clinic.

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