Hidradenitis suppurativa (HS) is a skin disease characterized by painful acne-like cysts and abscesses that can become infected. Hidradenitis suppurativa usually first begins after puberty, and if not diagnosed and treated early, symptoms tend to get worse over time. Hidradenitis suppurativa can affect one part of the body or several different areas, but usually occurs in areas containing a lot of oil and sweat glands, such as in the armpits and groin. It is also common in areas where skin rubs together, such as on the inner thighs. A person affected with hidradenitis suppurativa has chronically inflamed skin in these areas with painful lumps, blackheads, and pus-filled lesions that frequently break open.
Hidradenitis suppurativa can sometimes occur along with other impairments, like certain types of inflammatory bowel disease (such as Crohn's disease). Hidradenitis suppurativa can also cause serious complications. If the affected area is in the armpits, thighs, or groin, and the symptoms are severe, movement can be very painful. Hidradenitis suppurativa can also lead to cellulitis, which is a potentially serious skin infection that can spread to the bloodstream, causing sepsis.
While there is no cure for hidradenitis suppurativa or severe acne, there are treatment options that give some people relief. Some common medications prescribed to people who suffer from hidradenitis suppurativa include antibiotics, corticosteroids and immunosuppressants. In some cases, surgery is needed to drain lesions. In extremely severe cases, the affected skin may be entirely removed and replaced with skin grafts.
While some people with hidradenitis suppurativa have symptoms that are not debilitating and can be eased by things like frequent washing and use of an antibacterial medication, warm compresses, and making certain lifestyle changes, such as losing weight, other people with the impairment have disabling symptoms that do not respond to treatment.
If you have very severe symptoms, there are a few different ways you may be able to receive disability benefits: by meeting the requirements under the Social Security Administration's (SSA) medical listing for hidradenitis suppurativa or a related disability that may occur along with hidradenitis suppurativa, by showing symptoms that medically "equal" a different listed impairment, or by showing your symptoms are so limiting there is no work you can do.
In order to qualify for disability under the SSA's medical listing for hidradenitis suppurativa, your medical records must include a diagnosis of hidradenitis suppurativa with skin lesions on either both armpits, both sides of the groin, or on the perineum. The lesions must be extensive and must persist for at least three months.
If you don't meet the SSA's listing for hidradenitis suppurativa, you may be found disabled under a related impairment, such as cellulitis or Crohn's disease. If you have chronic skin infections such as cellulitis, you could qualify for disability under listing 8.04. The listing requires you to suffer from extensive festering or ulcerating sores that don't respond to a doctor's prescribed treatment for at least three months. In reality, unless you have severe ulcerating lesions that make it hard for you to walk or use your hands, you are unlikely to qualify under this listing.
If you don't meet one of Social Security's medical listings, the SSA will determine whether the severity of your symptoms is "equal to" another medical listing, such as the one for ichthyosis. For example, if you have hidradenitis suppurativa that is not located in any of the three areas specified in the hidradenitis suppurativa listing, but you do have extensive skin lesions that have persisted for at least three months, your condition might "medically equal" the listing for ichthyosis.
Some examples of what the SSA would consider "extensive skin lesions" are lesions on the palms of both hands or the soles of both feet that seriously limit your ability to use your hands or walk effectively and lesions that interfere with the movement of your joints, seriously limiting the use of your hands or feet (or one hand and one foot).
If none of the above steps lead to a determination of disability, the SSA will look at what is called your RFC, or "residual functional capacity." Your RFC assessment will show what kinds of work you can be expected to be able to do despite the limitations your impairment causes. The RFC assessment of people with hidradenitis suppurativa often includes limitations based on lesions on the hands, which would restrict actions such as writing, typing, grabbing, pushing, pulling, and other fine and gross motor movements. Lesions on the feet or other areas of the lower body might lead to restrictions on how much you can be expected to stand, walk, sit, or kneel, which might limit you to sedentary work.
Whether your RFC is limiting enough for the SSA to agree that you can't work depends a good deal on your prior work. If your past jobs all involved heavy lifting and you get an RFC of sedentary work, you clearly can't do your past job. And if you have a sedentary RFC that limits the use of your arms because of painful lesions in the armpits, there really wouldn't be many other jobs you could learn to do. In this case, you could be found disabled because your RFC is actually for less than sedentary work.
Alternately, if your hidradenitis suppurativa or related infections like cellulitis have caused you to be hospitalized numerous times in the past year, this is a good argument that you would be unable to hold down a full-time job with as many absences as your skin condition causes. For more information, see our section on disability and medical-vocational allowances.