What is vulvar hidradenitis suppurativa?

Can HS affect the vulva?

HS tends to manifest in areas where two areas of skin rub together or touch. While the underarm region is the most common site, it also occurs around the anus, groin, inner thighs, and buttocks.

The groin area includes the scrotum for males or the vulva for females. The prevalence of HS ranges from 1–4%.

Learn more about HS.

What causes vulvar hidradenitis suppurativa?

HS tends to begin in the hair follicles. Experts believe it develops when hair follicles clog up, forming nodules containing sweat, bacteria, and keratin — a protein found in skin, nails, and hair. When nodules rupture, it can result in the spillage of the contents into surrounding tissues and elicit an inflammatory response.

Medical literature does not speculate on the cause of HS in the vulva, specifically. However, genetic, behavioral, and environmental factors may play a role in the condition.

Experts note 33–40% of people with HS have a closely related family member with the condition, suggesting a hereditary influence. Behavioral and environmental factors may include obesity and smoking.

Hormones may also contribute since the condition is more prevalent in females than males. Additionally, taking hormones and menstruation seem to affect symptom severity.

Symptoms

HS typically manifests with deep-seated bumps that linger from days to months. As the condition progresses, thick fibrotic plaques and scars may form.

Stages

There are three stages of HS:

• Hurley Stage 1: This denotes the formation of fluid-filled bumps that do not leak under the skin or form scars.
• Hurley Stage 2: This refers to fluid-filled bumps that leak under the skin and form scars. The lesions — a term for the bumps, leakage, and scarring — may appear widely spaced or singly.
• Hurley Stage 3: This advanced stage entails bumps and many interconnected tunnels that are widespread over the affected area, leaving little or no uninvolved skin.

Learn how HS looks on the skin.

Diagnosis

There are no lab tests that can indicate a diagnosis of HS. While imaging tests also usually do not help, doctors sometimes use them. Additionally, bacterial cultures do not support a diagnosis unless a secondary infection is present.

Doctors may frequently base the diagnosis on a skin exam that shows bumps in the vulva or other areas typically affected by this condition.

Occasionally, performing tests on the fluid in the bumps can be beneficial to rule out other conditions that may involve the skin, such as Crohn’s disease. This is a type of inflammatory disease that can produce bumps under the skin.

Treatment

Generally, treatment aims to:

• reduce pain and drainage
• prevent progression
• decrease the frequency of recurrence

Depending on the severity, pain medications may be helpful. Some options include:

• topical agents, such as lidocaine
• acetaminophen
• systemic nonsteroidal anti-inflammatory drugs, such as ibuprofen

Specific treatment varies with the stages. Details are below:

Stage 1 treatment

Topical antibiotics — which a person applies directly to the skin — tend to be the first-line treatment option. The most effective is clindamycin (Cleocin T).

Administering corticosteroids, such as triamcinolone (Kenalog), into the lesions may lower inflammation, while punch debridement may promote healing. Punch debridement involves removing the top few millimeters of the lesion.

Stage 2 treatment

Doctors prescribe oral antibiotics — tetracyclines, such as doxycycline (Adoxa), are the most effective. They may combine this with other antibiotics.

Alternatives include:

• medications that block male hormones, such as cyproterone acetate (Cyprostat)
• oral retinoids, such as acitretin (Soriatane)
• systemic steroids, such as prednisone (Deltasone)

Stage 3 treatment

One option is tumor necrosis factor-alpha inhibitors, such as adalimumab (Humira).

However, surgery is frequently necessary to remove the entire affected area.

Managing at home

The National Institute of Arthritis and Musculoskeletal and Skin Diseases advises people can manage HS at home by:

• keeping the areas clean
• using warm compresses
• maintaining an optimal weight
• stopping smoking, if necessary

Complications of vulvar hidradenitis suppurativa

Some people may experience certain complications. These include:

• chronic, or long-term pain
• effects from chronic inflammation, such as high protein levels in the blood and anemia
• infection that leads to systemic infection — infection affecting multiple body organs or systems in the body
• psychological effects, such as depression and social isolation

Rarely, HS lesions can sometimes turn into squamous cell carcinoma, a cancer affecting the middle and outer skin layers. It primarily affects males but can affect females and sometimes involve the vulva, notes a 2022 review.

Outlook

There is no cure for vulvar HS, but early diagnosis and effective treatment can improve a person’s outlook. However, the condition requires constant management.

A doctor can help people find suitable treatments, including medications and home remedies, to help manage their symptoms.

A person may also consider joining an online support group.

Summary

Hidradenitis suppurativa (HS) of the vulva involves the presence of deep-seated bumps that can rupture and leak under the skin. When it advances, it can cause interconnecting tunnels and scars.

Genetic, behavioral, and environmental factors may play a role in why someone might experience vulvar HS.

Doctors usually form a diagnosis by examining the bumps where it tends to manifest.

While there is no cure for HS, early treatment can make a difference in a person’s outlook. Treatments can vary with the stage but ultimately aims to prevent progression and reduce recurrence. Stopping smoking if necessary and maintaining an optimal weight can help people manage the condition.