HS and Staph: What You Need to Know About Skin Infections
"Uncover the link between Hidradenitis Suppurativa (HS) and Staphylococcus epidermidis, including antibiotic resistance and biofilm formation."
Hidradenitis Suppurativa (HS) is a chronic skin condition characterized by painful lumps, boils, and scarring, primarily in areas where skin rubs together. While not considered a simple infection, bacteria play a significant role in its development. Understanding the interplay between bacteria and the immune system is crucial for managing this condition.
One common bacterium found on the skin is Staphylococcus epidermidis. While typically harmless, in HS patients, these bacteria can contribute to the problem, especially when they form biofilms, which are structured communities of bacteria that are more resistant to antibiotics and the body's defenses. This article examines how S. epidermidis behaves in HS lesions and how antibiotic choices can be impacted.
This article translates findings on S. epidermidis strains isolated from HS patients, focusing on their antibiotic susceptibility and biofilm-forming capabilities. Ultimately, the aim is to provide practical insights into managing HS in the context of bacterial involvement and antibiotic resistance.
HS prevalence and impact
Hidradenitis suppurativa (HS), also called acne inversa, is a chronic inflammatory skin condition that can significantly affect quality of life. A 2024 epidemiology review reports that estimated prevalence varies substantially with study methodology, while the true prevalence may range from approximately 0.1% to 1%. It also describes HS as disproportionately affecting women and Black Americans and predominantly affecting younger adults. A 2026 systematic review and meta-analysis set out to estimate global prevalence, reflecting the variation across populations and the need for a broader burden assessment.
Multimodal HS management
HS management can be challenging and often requires a multimodal approach, including on-label and off-label medications. A 2025 practical management algorithm responds to the rapid expansion of treatment options since the 2019 North American HS clinical management guidelines. Contemporary international guidelines increasingly endorse combining medical and surgical care, though the evidence, outcomes, indications, and limitations of these approaches remain subjects of critical review. Separately, a 2025 consensus statement establishes morphological definitions of HS lesions and guidance to standardize investigator assessments in clinical trials.
A changing understanding of HS
HS has a complicated history shaped by conflicting knowledge about the condition and its pathogenesis. Since its first description in the 19th century, it has been known by various names and treated in different ways, contributing to confusion among researchers, physicians, and affected individuals. Alfred Velpeau and Aristide Verneuil are identified as prominent figures in its early medical history. For much of history, recurring abscesses and sinus tracts were mistaken for common boils or signs of systemic infection.
How Does Staph. Epidermidis Impact HS?
Researchers collected skin samples from HS lesions and nearby unaffected skin to study the S. epidermidis present. They looked at how well the bacteria grew, formed biofilms, and responded to common antibiotics. A key finding was that a significant number of S. epidermidis strains isolated from HS patients showed resistance to clindamycin, a frequently used antibiotic. Rifampicin, on the other hand, proved to be more effective at inhibiting bacterial growth and breaking down biofilms.
- Biofilm Formation: A large majority of the strains could form strong biofilms, making them tougher to treat.
- Antibiotic Resistance: Many strains showed resistance or reduced sensitivity to clindamycin and tetracycline.
- Rifampicin Effectiveness: This antibiotic was generally more effective at killing the bacteria and disrupting biofilms.
Recent research on HS bacteria and tunnels
A narrative review of bacterial infections in HS reports that Ardon and colleagues biopsied 26 patients, sampling active lesions— inflammatory nodules and/or sinuses—as well as non-involved skin. A systematic review of the HS tunnel microbiome included eight studies, covering 418 patients, 632 HS lesions, 360 HS tunnels, and 300 controls. These reviews examine bacterial and microbiome findings in HS, while the supplied summaries do not state specific results from the biopsy study or the systematic review. A separate review on medical-device-associated biofilms discusses catheter-associated urinary tract infections, which it identifies as the most common hospital-acquired infections worldwide and as accounting for up to 40% of nosocomial infections.
What This Means For HS Management
This research highlights the importance of considering antibiotic resistance and biofilm formation when treating HS. The reduced sensitivity to common antibiotics like tetracycline and clindamycin is concerning, as these are often used in HS management. The fact that Rifampicin may have better results shows that there are still options.
It's important to note that HS treatment is not only about killing bacteria. Managing inflammation and supporting the immune system are also key. However, understanding the specific characteristics of the bacteria involved can help tailor treatment strategies.
Future studies should focus on further understanding the relationship between the skin's immune response and S. epidermidis in HS patients. People with HS can help by openly discussing treatment history with their physicians, as this can help determine what antibiotics are most effective.