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How Does Hidradenitis Suppurativa Affect Teens?

Becoming a teen means growing up, and looking forward to more freedom and new adventures. However, teens living with hidradenitis suppurativa, a painful skin disease, face a number of challenges.

What is HS?

Hidradenitis suppurativa, or HS, is a chronic inflammatory skin disease. HS generally appears after puberty, during or after the teen years.1

The disease begins when clogged hair follicles cause bumps. The process leads to:2

  • Abscesses
  • Pus
  • Inflammation
  • Tunnels under the skin
  • Scars

Symptoms are worse during flares that happen at different times.3

HS among young people

Even though acne is a common skin disorder among teens, few teens have HS. The condition affects only 15 out of every 100,000 people between the ages of 0 and 17. That is much lower than the rate – 172 out of every 100,000 people – reported for the most common age group of 30 to 39 years old.4

If you are younger than 17 when HS begins, you probably are female and have a:5,6

  • Family history of HS
  • Hormonal imbalance
  • Pilonidal sinus, a small hole or tunnel in the skin at the top of the buttocks, where they divide
  • Highly inflammatory form of acne
  • Longer duration of HS
  • Feeling that your HS is severe

Less than 2 percent of people with HS are younger than 11 years old when the disease begins.7

Getting diagnosed

There is no test to determine if a person has HS. A dermatologist, a doctor specializing in the skin, diagnoses HS by:8,9

  • Appearance of the lesions, or sores
  • Lesions in the typical locations of the armpit, groin, under the breasts, on the buttocks, and in the anal and genital areas
  • Recurrence
  • Age of onset of symptoms
  • Poor response to antibiotics
  • Lack of infection that affects the whole body

Many people with HS see other doctors before going to a dermatologist. That delays diagnosis as much as 7 years, because other doctors may not be not familiar with the disease. HS is not common – doctors believe that only about 4 out of every 100 people in the United States have the condition.4,8

Going to a dermatologist first could speed up the diagnosis. A quicker diagnosis would ensure quicker, more effective treatment, and a reduction in the number of school or workdays lost.8

Treatment

The goals of HS treatment are to:5

  • Reduce pain
  • Decrease inflammation and scarring
  • Prevent spread of the disease
  • Postpone the need for surgery

There is no cure for HS. There is not 1 best treatment that is used by doctors. Instead, treatment depends on the person. It usually includes a combination of several different methods. For teens, treatment may include:2,10

  • Local medicines, including topical antibiotics for the surface of the skin or steroid injections, which are directly injected into the lesions
  • Systemic medications that work throughout the body, including painkillers, antibiotics, antiandrogens to reduce male hormones, steroids, and tumor necrosis factor alpha blockers (proteins to reduce immune system response and inflammation)
  • Surgery for scarring lesions

To help teens better manage their HS, their doctor may:11

  • Discuss following directions to take medicines as prescribed
  • Screen for other diseases that often occur at the same time as HS
  • Recommend ways to change your lifestyle to reduce HS flares

Quality of life

If you are a teen, HS can seriously damage your quality of life. While you are maturing physically and sexually, you are sensitive to what other people think of you. HS makes the normal threats to your self-esteem and body image even worse. The pain, odor, pus, and appearance of HS increase your challenges at school and at work.11

People with HS often have feelings of anxiety, social isolation, and depression. Your doctor can help you find resources to deal with those feelings.12

Written by: Ina Fried | Last reviewed: December 2020
  1. Naik HB, Paul M, Cohen SR, et al. Distribution of self-reported hidradenitis suppurativa age at onset. JAMA Dermatol. 2019 Jun 5;155(8):971-973. doi:10.1001/jamadermatol.2019.0478.
  2. Seyed Jafari SM, Hunger RE, Schlapbach C. Hidradenitis suppurativa: current understanding of pathogenic mechanisms and suggestion for treatment algorithm. Front Med (Lausanne). 2020 Mar 4;7:68. doi:10.3389/fmed.2020.00068.
  3. Jemec GBE. Clinical practice: Hidradenitis suppurativa. N Engl J Med. 2012 Jan 12;366(2):158e64. doi:10.1056/NEJMcp1014163.
  4. Garg A, Kirby JS, Lavian J, et al. Sex- and age-adjusted population analysis of prevalence estimates for hidradenitis suppurativa in the United States. JAMA Dermatol. 2017 Aug;153:760-764. doi:10.1001/jamadermatol.2017.0201.
  5. Liy-Wong C, Pope E, Lara-Corrales I. Hidradenitis suppurativa in the pediatric population. J Am Acad Dermatol. 2015 Nov;73(5 Suppl 1):S36-41. doi:10.1016/j.jaad.2015.07.051.
  6. Molina-Leyva A, Cuenca-Barrales C. Adolescent-onset hidradenitis suppurativa: prevalence, risk factors and disease features. Dermatology 2019;235:45-50. doi.org/10.1159/000493465.
  7. Palmer RA, Keefe M. Early-onset hidradenitis suppurativa. Clin Exp Dermatol. 2001;26(6):501-503. doi:10.1046/j.1365-2230.2001.00876.x.
  8. Napolitano M, Megna M, Timoshchuk EA, et al. Hidradenitis suppurativa: from pathogenesis to diagnosis and treatment. Clin Cosmet Investig Dermatol. 2017;10:105‐115. doi:10.2147/CCID.S111019.eCollection 2017.
  9. Margesson LJ, Danby FW. Hidradenitis suppurativa. Best Pract Res Clin Obstet Gynaecol. 2014 Oct;28:1013-1027. doi.org/10.1016/j.bpobgyn.2014.07.012.
  10. Mikkelsen PR, Jemec GBE. Paediatr Drugs. 2014 Dec;16(6):483-489. doi:10.1007/s40272-014-0091-3.
  11. Collier E, Shi VY, Hsiao JL. Management of adolescents with hidradenitis suppurativa. J Dermatolog Treat. 2020 Jan 23;1-4. doi:10.1080/09546634.2020.1716933.
  12. Patient perspectives: What is hidradenitis suppurativa (HS)? Society for Pediatric Dermatology. Available at https://pedsderm.net/for-patients-families/patient-handouts/. Accessed 7/9/2020.