the Difference: Lipoma vs. Hidradenitis Suppurativa

Is it a sebaceous cyst or hidradenitis? What should I do?

Hello, doctor.
I first developed symptoms in my first year of high school, with a lump in my left armpit.
At that time, the doctor at the hospital diagnosed it as a sebaceous cyst.
Later, the left side became infected, so they performed a drainage procedure, and subsequently, I had surgery to excise it.
However, I have experienced recurrence about 3 to 4 times.
I underwent a total of two surgeries on the left armpit at this hospital, but it did not improve.
During this time, after the surgery on the left side, a lump also appeared on the right side, but the doctor only performed an outpatient drainage procedure, and it resolved without further issues.

I later transferred to another hospital because the left armpit continued to swell, hurt, and become infected.
I had another surgery there, and the doctor excised deeply, discovering a small cyst on the lymph node, which was also removed.
However, it recurred again.
Eventually, I was referred to another hospital, where the doctor stated that the initial diagnosis from the first hospital was incorrect and that I likely have a subcutaneous cyst.
After experiencing another infection in the left armpit, I had another surgery.
Now, in my third year of college, the left armpit has completely healed, but my right armpit has started to hurt again.
When I asked the doctor, he said it was hidradenitis suppurativa, so I have been prescribed antibiotics and received injections.
However, I have been on one type of antibiotic for so long that it has caused issues in my body, so the doctor switched me to another medication.

I asked the doctor why my body is so prone to recurrence, and he said it is due to my constitution (I have a hot and humid body type).
From my first year of high school until now, I have been dealing with this for almost six years, with intermittent recurrences.
What should I do now? Should I change hospitals, or should I continue taking antibiotics, even though they seem ineffective now (I am still in an inflammatory state)? Or should I consider surgery again? Is this condition uncontrollable?

Xiao You, 20~29 year old female. Ask Date: 2015/08/05

Dr. Wu Yuxin reply Dermatology

These two conditions are actually quite similar, with similar symptoms and treatments, and they are prone to recurrence.
In addition to oral medications, timely debridement is necessary in the treatment.

Reply Date: 2015/08/05

More Info

Understanding the difference between lipoma and hidradenitis suppurativa (HS) is crucial for effective diagnosis and treatment. Both conditions can present with lumps or nodules, but they have distinct characteristics, underlying causes, and treatment approaches.

Lipoma is a benign tumor composed of adipose (fat) tissue. It is typically soft, movable, and painless, often found just beneath the skin. Lipomas can occur anywhere on the body but are most commonly seen on the torso, arms, and thighs. They grow slowly and usually do not cause any symptoms unless they press on nearby structures. Treatment for lipomas is generally not necessary unless they become bothersome or painful, in which case surgical removal is the most common approach.

On the other hand, hidradenitis suppurativa is a chronic inflammatory skin condition characterized by the formation of painful lumps, abscesses, and sinus tracts, primarily in areas where skin rubs together, such as the armpits, groin, and under the breasts. HS is associated with inflammation of the hair follicles and is often linked to other conditions, such as obesity, metabolic syndrome, and Crohn's disease. Unlike lipomas, HS can be recurrent and may lead to scarring and significant discomfort. The treatment for HS can be more complex and may include antibiotics, anti-inflammatory medications, hormonal therapy, and in severe cases, surgical intervention to remove affected tissue.

In your case, it seems that the initial diagnosis of a lipoma may have been incorrect, and you may actually be experiencing hidradenitis suppurativa. The recurrent nature of your symptoms, especially the painful and purulent nodules, aligns more closely with HS. The fact that you have undergone multiple surgeries and still experience flare-ups suggests that the underlying condition has not been adequately addressed.

Given your history of recurrent infections and the ineffectiveness of antibiotics, it might be beneficial to consult with a dermatologist who specializes in hidradenitis suppurativa. They can provide a comprehensive evaluation and may recommend a treatment plan tailored to your specific situation. This could include lifestyle modifications, such as weight management and hygiene practices, as well as medical therapies that target the inflammatory aspect of HS.

It's also important to discuss the possibility of systemic treatments, such as biologics, which have shown promise in managing hidradenitis suppurativa. These medications work by targeting specific pathways in the immune system and can help reduce the frequency and severity of flare-ups.

In summary, while lipomas are benign and often require little to no treatment, hidradenitis suppurativa is a chronic condition that may require a more aggressive and multifaceted approach. If you continue to experience symptoms, it would be wise to seek a second opinion from a specialist who can provide a more accurate diagnosis and effective treatment options. Managing HS can be challenging, but with the right care, it is possible to achieve better control over the condition and improve your quality of life.

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