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68 m a s s a g e & b o d y wo r k m a rc h /a p r i l 2 0 2 2 Boiling Over The Frustrations of Hidradenitis Suppurativa By Ruth Werner Author note: Vicki Stewart Winston is a massage therapist and educator in Tennessee. Although she has had symptoms for decades, she was only recently officially diagnosed with hidradenitis suppurativa (HS). She generously shared her experience to help with this article. When Vicki Stewart Winston was 19 or 20 years old, she began to develop painful cystic boils along her panty line. She thought it was acne and that it was some kind of reflection on her cleanliness. But no matter what she did, the boils kept appearing. At age 25, getting ready for a beach vacation, she got a bikini wax and sugar scrub. Almost immediately, golf-ball–size cysts emerged in her axillae and groin. They were extremely painful, and eventually she had one lanced. Her doctor said, in reference to the scarring that was already developing, "Well, you'll never be a bikini model." To this day, the lesions keep coming, sometimes one at a time, sometimes in clusters. They are typically about the size of a nickel, and they are red, angry, and painful. She gets them at her axillae, her inguinal line, in the gluteal fissure, and along the bra line and under her breasts. They are usually filled with blood and exudate. Sometimes they are so painful that she picks at them to relieve the pressure, and this has caused significant scarring. And even when her boils are not active, she has permanent scars and discolored areas. Vicki's recent diagnosis gives her some new tools: She has found a community of other patients and a doctor who is familiar with this situation. Her next challenge is to find some treatment options that might help her control this very difficult, common, mysterious, and frustrating condition. SWEAT GLAND REVIEW To describe and define HS, we need to do a quick review of sweat glands. Humans have two types of sweat glands: apocrine glands and eccrine glands. Eccrine glands are distributed all over the body, essential skills | PATHOLOGY PERSPECTIVES and they open directly onto the surface of the skin. The sweat they secrete is typically odorless. Apocrine glands, by contrast, are located specifically in areas where hair follicles are numerous. They connect to hair follicles and use those passageways to release their secretions to the skin. Sebaceous glands, which secrete sebum, are also located at hair follicles, but they are separate from apocrine glands. This distinction is important to understand HS. WHAT IS HIDRADENITIS SUPPURATIVA? Many experts describe HS as a defect in the follicular epithelium. Others suggest that it starts with apocrine gland obstruction, and follicular damage is secondary. Most agree that it does not involve infected sebaceous glands, which differentiates it from common acne or folliculitis. Whatever the root of the problem, the result is painful inflammation, abscesses that fill with blood and