Hidradenitis Suppurativa

Imagine that you’re going about your life one day, and you notice that you have been scratching at the same dime-sized spot of skin for the past few hours now–let’s say it’s on your underarm. Or maybe it’s tender, so you keep rubbing it. Either way you notice it, but in passing annoyance.

You continue about your day.

Later you start to feel a bit run down. “Am I coming down with something?” you wonder. You feel rather achy, and that spot on your underarm–whether it be itchy, tender, or both–is starting to firm up beneath the skin. Maybe you were bit by a spider while you slept last night.

Your day continues. As you go about your business you notice your underarm becoming more sensitive by the hour. As you move your arm you feel a burning pain radiating from the spot. The itching intensifies. What on earth bit you? You may duck into a bathroom to check it out. The skin is red, tense, and raised. There may even be a bit of a bump on the surface. You touch it and discover that beneath the skin, there is a firm lump the size of a quail egg. The pain is an excruciating, stabbing burn that radiates down your arm.

You finish your day and are getting ready for bed. You may be turning in a bit early due to fatigue or you may have toughed it out until your regular bedtime. You take some over the counter pain meds, and climb into bed gingerly, trying to not disturb the boil–which is quite swollen by now and may be anywhere from red to purple in color. Your underarm aches, and you drift off into a fitful slumber.

A day or two passes. The boil has swelled into a monster–half-above and half-beneath your skin–somewhere between golf ball and baseball-sized. You make an appointment with your doctor, who looks at it, only sees what is on the surface, then tells you to take some acetaminophen and to clean better when you shower [and take more showers]. If you’re overweight, they also tell you to lose weight. You go home. You feel like you’re going to come down with a cold any minute–achy, sweaty, tired, cranky. The boil throbs even when you’re not moving your arm, and makes doing anything difficult.

That night you go to sleep, and wake up a few hours later. You notice that your arm isn’t as tender, but there is an awful smell, and that the underarm area of your T-shirt is damp. You turn on the light in the bathroom to find that the boil is now oozing a milky, bloody mixture that smells absolutely terrible! You try squeezing it but not much more comes out, despite how much there is on your shirt. You put a topical ointment on it, a bandage, change your shirt [and maybe bedding] and head back to bed.

The next morning your underarm throbs. Every movement of your arm causes a radiating, burning pain. It feels raw and bruised despite it opening up. And it’s still oozing that fluid.

This continues. It might continue for a few days, or it might continue indefinitely. Over time, more of the boils appear. If they heal, they leave behind horrible white or purple scars. If they don’t heal, they will constantly bleed, and/or ooze a clear to milky fluid that smells like something died. New boils will appear inside of the scars, and old, healed lesions will open up again. Multiple boils will form close together and create a tract of tight, inflamed skin over a large area. You see your doctor over and over again with the same results–they tell you to clean yourself better and/or to lose weight. Sometimes you receive antibiotics if it looks like you may also have an infection, but that is rare.

Over time you become self-conscious. You change your routine, trying to not irritate the affected area. You stay home on days where the smell from the open sores are too bad, or when the pain from moving is too great. Over the counter pain medicine does nothing to alleviate the deep-seated throbbing, stabbing, and/or burning pain that comes from these boils. Any kind of pressure is agony, and they tend to form in the worst possible places. You’ll distance your friends. You may lose your job. You constantly feel rundown and achy. Your sleep suffers. You gain weight from inactivity. Each day becomes a chore to complete.

This continues for years, unchecked. You cycle through periods of flare ups and remissions where it’s not so bad, but as time goes on, the “good days” become few and far-between. You begin having “not-as-bad-as-normal days” instead. The aching, pain, and tenderness is constant. You may begin to get boils in other areas as well.

Some day you might get lucky. You may find yourself in the emergency room, at the end of your rope due to a massive softball-sized boil, and luck into a doctor who not only wants to lance it so you can get some relief, but knows that you have a legitimate disease–and that it has nothing to do with poor hygiene like your doctor has been saying. Others won’t be so lucky, and might go through life thinking that they are prone to getting boils, that they somehow aren’t washing properly, or that it has to do with weight. But if you do get a diagnosis, just knowing these things can be so freeing!

This disease is called Hidradenitis Suppurativa, often abbreviated simply as HS. It is a rare, extremely painful, debilitating autoimmune disease with everyday pain rated between 4-10 out of 10, and an average DLQI rating of 10-18; that’s more painful and debilitating than most well-known chronic, disabling medical conditions, and on par with the pain experienced by cancer patients. 1-4% of the world’s population is affected by it, and those are only the people who have overcome the shame and embarrassment of the condition to get a diagnosis. In fact, it is an invisible illness; the people affected by it hide it for as long as possible, and it’s usually in areas covered by clothing. It is also shown to be hereditary and often runs in families. There is no cure. It can be semi-managed, but that is all.

In the UK this is HS Awareness week, and those of us affected by this disease in the US are adopting this week to promote HS awareness as well.

Until this point, I have only told family about having HS. I have it in an embarrassing area that is difficult to manage, and it hinders my ability to walk, stand, and sometimes even sit on a regular basis. It makes it so that I can only leave my house once a week due to the mess and pain. I’ve had to change a lot about my life due to it. After my car accident it was easier to blame my HS flares on my back, and I still do to people who don’t know. I can’t wear certain types of clothing, going to the bathroom is a struggle at best, and I can’t be as active as I would like to be. The consequences are far too great. It has become especially bad since having my daughter. I was officially diagnosed about two years ago, and my current flare up has been three years long. Three years with no relief! This is part of the reason I decided to begin writing in the first place–it’s something that I can do from home, and it distracts me from my pain.

I suffered for fifteen years before I was diagnosed. I had been running a high fever and unable to keep down food or water for twenty-four hours, so my husband made me go to the ER. They couldn’t figure out why my white blood count was so high, but I wasn’t going to mention the oozing, open wounds I had because I was too ashamed. My husband finally suggested it might be from the sores and the ER doctor insisted on having a look. It turned out that one of my boils had become infected. The ER doctor sat me down and walked me through the HS diagnosis, and recommended I go see a dermatologist, as they are the specialists who are trained to handle HS. She also told me that Hidradenitis is NOT contagious. You cannot catch it from anyone. It is not due to poor hygiene. It is not due to being overweight–though sometimes that can exacerbate it. It is not due to anything within an affected person’s control.

Hidradenitis is a vile disease, and I’ve never made pains to hide it from my husband because he’s seen me naked pretty much since the onset of my HS. He has been by my side as it has become progressively worse, and he has seen how debilitating it has become. I am extremely fortunate that he handles the disgusting nature of this well. I am in several support groups for people with HS, and many in them have lost partners due to them not being able to deal with the symptoms of this disease.

I saw the dermatologist again last week, and we discovered that I am now at stage three. In the past when I was stage two, I had been recommended to have surgery to remove most of the skin on the lower half of my torso and replace the skin with a skin graft from my thighs and hips. I didn’t have the support to be able to have a surgery like that, as it will require weeks of recovery and I have a young child at home that needs constant supervision. I still don’t have that kind of support, so surgery is off the table.

A recent discovery has been that the drug Humira helps some people suffering from HS, so after talking with my dermatologist we are going to try that. This has come about due to increased awareness about HS, so I am working through my shame and writing this in the hopes that someone who has it might read it, and get the help they need. [Or that someone who knows a person with these symptoms might encourage them to look into HS further and talk to their doctor about it.]

It is embarrassing, but those of us suffering through this need to put aside our humiliation and speak out in the hopes that maybe some day, there will be a cure, and we can regain some semblance of having normal lives.

If you want to support awareness, please share this post or visit http://www.hs-foundation.org and make a contribution. Also, if you shop at Amazon, [like where my books are sold!] why not go through Amazon Smile and set your charity as Hidradenitis Suppurativa Foundation Inc? When you use Smile, Amazon donates 5% of your purchase price to the charity of your choice! It’s easy and painless–unlike HS.

To find out more about Hidradenitis Suppurativa, please visit No BS About HS.

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