What to Know About Hidradenitis Suppurativa on the Breast
Hidradenitis suppurativa (HS) is a chronic skin condition where painful nodules (growth or lump) develop under your skin. If left untreated, HS can worsen and lead to the formation of skin tunnels and scarring.
Researchers estimate that HS may impact up to 1% of people worldwide.
It often develops on areas of the body where skin touches skin, such as the armpits, groin, and under the breasts. In some cases, it may also form on the breast.
Learn more about the symptoms of HS on the breast, as well as how it can be diagnosed and treated.
What are the symptoms?
In HS, deep nodules form under the skin that can often initially be mistaken for an acne cyst or a boil. At first, most people with HS only have one nodule in the affected area. However, more nodules can occur and recur as time passes.
People with HS typically develop one to two new lesions each month. You may feel a burning, itching, or painful sensation 12 to 48 hours before one forms.
Over time, HS nodules can become larger or join together, forming painful abscesses or tunnels under the skin. These may also break open and drain pus. Repeated breaking and healing of the skin can lead to scarring.
In rare cases, inflammation and scarring from HS can also cause a blockage in the lymphatic system, resulting in lymphedema. This has also been documented in HS on the breast. Lymphedema affecting the area of the breast can cause:
swelling or a feeling of heaviness in the breast, chest or arm
sensations of pain, itching, or numbness and tingling
skin changes like discoloration, thickening, or dryness
reduced range of motion that can affect daily activities
The effects of HS can also have a significant impact on quality of life. This can include things like poor quality sleep, challenges with daily activities, low self-confidence, and an increased risk of anxiety and depression.
How is it diagnosed?
A prompt diagnosis of HS of the breast is important. This is because treatment can help to ease symptoms and prevent new lesions from forming.
However, diagnosing HS can be challenging because it can look like other skin conditions, such as acne, boils, or cysts.
In order to diagnose HS on the breast, a healthcare professional will first get a thorough medical history. During this time, they'll ask about your lesions, when you first noticed them, and if they can be found anywhere else on your body.
They'll then do a careful examination of the skin of your breast to look for features characteristic of HS. Things they'll be looking for include:
deep nodules under your skin
abscesses
skin tunnels
scarring
They may also collect a sample of fluid from your lesions to test for an infection. They could also recommend breast imaging via mammogram, ultrasound, or MRI to help rule out other breast conditions.
What treatment options are available?
HS is typically treated with medications. However, surgical procedures may be suggested if your symptoms are severe.
Some HS medications are topical, meaning that you'll apply them directly to the skin of your breast. Topical medications are often used for milder HS and include the antibiotic clindamycin and resorcinol cream.
Some HS medications are given orally or by injection. This allows them to work throughout your body. Examples of such medications include:
In some situations, a procedure or surgery may be recommended to drain or to remove abscesses or tunnels. The extent of surgery can depend on how severe the lesions are.
It's also important to address anxiety or depression that's associated with HS. This can be done using medications, talk therapy, or a combination or both.
What lifestyle measures can help?
In addition to medications or procedures, there are many lifestyle measures that you can take to help with HS on the breast. These include:
avoiding squeezing, picking, or scrubbing at your skin, as this can lead to more irritation, inflammation, or infection
applying a warm compress to ease painful nodules
limiting sweating by using a mild antiperspirant, keeping living spaces cooler, and reducing physical activity in warm environments
ensuring that you wear undergarments and clothing that help to support your breasts
wearing looser, breathable clothing to prevent skin from rubbing together
taking steps to manage weight if you have overweight or obesity, including eating a healthy diet, which may help improve HS
quitting smoking, if you do smoke, as smoking can worsen HS symptoms
Most people with HS will need dressings at some point to cover lesions that are open or draining fluid. Be sure to carefully follow all wound care instructions provided by a healthcare professional.
Takeaway
HS is a chronic skin condition that can sometimes impact the breast. It can lead to painful nodules, abscesses, and tunnels under the skin as well as scarring.
A healthcare professional can diagnose HS on the breast based on a medical history and a skin exam that looks for characteristic signs of HS. Breast imaging may also be used to rule out other medical conditions affecting the breast.
HS is typically managed using lifestyle measures and medications, which may be topical, oral, or injected. Surgery may be recommended in severe situations. Timely diagnosis and treatment can help to improve outlook.
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