About hidrosadenitis suppurativa

What is hidrosadenitis suppurativa?

Hidradenitis suppurativa (HS) is a chronic condition characterized by swollen, painful lesions, occurring in the armpit (axillae), groin, anal, and breast regions. This disease occurs due to obstruction of hair follicles and secondary infection and sometimes inflammation of certain sweat glands (apocrine glands). It is a progressive disease where single boil-like, pus-filled abscesses become hard lumps, then painful, deep-seated, often inflamed clusters of lesions with chronic seepage. Healing of affected areas is typically associated with progressive scarring (fibrosis). Formation of chronic epithelialized, sometimes interconnected, sinus tracts occur in severe disease. This often leads to the entrapment of perspiration and bacteria in the surrounding tissue, which causes the inflammation and infection. HS can be extremely painful and debilitating but is rarely life threatening; only occurring when the bacteria infection leads to an overwhelming systemic infection in an individual with a weakened immune system.

HS was once thought to be a rare disorder because only the most severe cases were reported. HS was first described in the medical literature by Velpeau in 1839 and was considered an extremely severe form of acne (acne inversa). It most often presents at puberty because changes in hair follicles triggered by the surge in sex hormones. The condition may also begin to occur in patients of any age after puberty, but rarely before. Cases vary in severity, but all require some treatment and management. For mild cases, home remedies may be all that is needed. For severe forms however, daily medication is often prescribed and radical surgery may eventually be recommended. Early diagnosis and treatment of HS is important because it can help manage symptoms and prevent new boils and lesions from forming.



What are the symptoms for hidrosadenitis suppurativa?

Oedema symptom was found in the hidrosadenitis suppurativa condition

Some people with this condition experience only mild symptoms. The course of the disease is highly variable. Excess weight and being a smoker are associated with worse symptoms, but even people who are thin and don't smoke can experience severe disease.



What are the causes for hidrosadenitis suppurativa?

Hidradenitis suppurativa develops when hair follicles become blocked. The exact cause for this isn't known. Experts think it could be connected to hormones, genetic predisposition, cigarette smoking or excess weight.

Hidradenitis suppurativa is not caused by an infection or being unclean, and it can't be spread to other people.



What are the treatments for hidrosadenitis suppurativa?

Treatment with medications, surgery or both can help control symptoms and prevent complications of hidradenitis suppurativa. Talk with your doctor about the risks and benefits of the treatment options and how to develop an approach tailored to you.

Expect to have regular follow-up visits with your dermatologist. Some people might need the comprehensive care provided by a multidisciplinary health care team.

Medications

Your doctor might prescribe one or more of the following types of medications:

  • Antibiotics applied to the skin. Mild symptoms might be managed with a topical antibiotic in liquid or gel form. For more-widespread disease, your doctor might prescribe antibiotic pills, such as doxycycline (Monodox), clindamycin (Cleocin), rifampin (Rimactane) or both. People with severe disease might need to take antibiotics for months.
  • Steroid injections. Triamcinolone (Aristospan, Kenalog-10) injected into the sores might help reduce swelling and inflammation.
  • Hormonal therapy. Hormone pills, such as estrogen-containing combined oral contraceptives (Estrace, Prefest), might be effective for people with mild hidradenitis suppurativa.
  • Biologics. These drugs, usually administered by injection, alter the immune system in a way that disrupts the disease cycle and improves symptoms and signs of disease within weeks. Several of these drugs are approved for the treatment of moderate to severe hidradenitis suppurativa. Two of them are the tumor necrosis factor (TNF) inhibitors adalimumab (Humira) and infliximab (Remicade). Many other biologics are in clinical trials for hidradenitis suppurativa.
  • Retinoids. Oral retinoids might be an option for some people with acnelike (acneiform) disease. These drugs are not recommended when you're pregnant or breastfeeding or if you intend to become pregnant.
  • Pain medication. If over-the-counter pain relievers don't help, your doctor might prescribe a stronger pain medication or refer you to a pain clinic.

Surgery

Combined medical and surgical approaches help manage hidradenitis suppurativa. Surgery is an important part of disease management when a tunnel and bump (abscess) are present. Which surgical approach is right for you depends on the extent and severity of your condition. Talk with your doctor about the risks and benefits of the options, which include:

  • Uncovering the tunnels. This procedure involves removing tissue (unroofing) to expose the tunnels under the skin. It's used for people with moderate or severe hidradenitis suppurativa. This solution usually doesn't have to be repeated.
  • Punch debridement. This procedure, also called limited unroofing, involves removing a single inflamed bump.
  • Laser therapy. A carbon dioxide laser can be used to make hidradenitis suppurativa sores go away. After this type of treatment, the sores are not likely to return. Laser hair removal can help hidradenitis suppurativa in early stages.
  • Surgical removal. This approach might be an option for people with persistent or severe symptoms. It involves removing all of the affected skin. A skin graft might be needed to close the wound. Even after surgery, sores might still occur in other areas.
  • Incision and drainage. Surgical drainage is no longer considered an effective option for treating hidradenitis suppurativa. The method might be considered to provide short-term pain relief, but afterward, sores usually flare again.



What are the risk factors for hidrosadenitis suppurativa?

Factors that increase your chance of developing hidradenitis suppurativa include:

  • Age. The risk of hidradenitis suppurativa is higher for people in their 20s and 30s.
  • Sex. Females are more likely to develop hidradenitis suppurativa than are males.
  • Race. Ethnicity or race might affect risk level. In the United States, the condition's prevalence is disproportionately high among Black people.
  • Family history. A tendency to develop hidradenitis suppurativa can be inherited.
  • Certain conditions. Hidradenitis suppurativa is more common and severe in people who are overweight. It also has an association with severe acne, arthritis, diabetes, metabolic syndrome and inflammatory bowel disease.
  • Smoking. Smoking tobacco has been linked to hidradenitis suppurativa.



Is there a cure/medications for hidrosadenitis suppurativa?

The goal of treatment for Hidrosadenitis suppurativa is to prevent the formation of new lesions and to manage the symptoms of pain and suppuration of current lesions.

  • Treatment is a combination of medications, surgery or both.
  • Combined medical and surgical approaches help manage hidradenitis suppurativa.
  • Surgery is an important part of disease management when a tunnel and abscess are present.
  • Application of topical antibiotic gels and ointments- clindamycin 1% solution.
  • Oral systemic antibiotics pills include tetracycline, doxycycline -Monodox, clindamycin -Cleocin, rifampin -Rimactane or both.
  • Steroid injections- Triamcinolone -Aristospan, Kenalog-10.
  • Hormonal therapy involves treatment with Hormone pills, such as estrogen-containing oral contraceptives -Estrace, Prefest.
  • Cyproterone acetate, an antiandrogen and progestin medication, used by itself or in combination with oral contraceptive pills.
  • Drugs, like the tumor necrosis factor -TNF inhibitors adalimumab -Humira and infliximab -Remicade.
  • Oral retinoids like Acitretin.
  • Pain medication such as lidocaine -Ztlido, nonsteroidal anti-inflammatory drugs -NSAIDs, Acetaminophen -Tylenol and opioids.
  • Punch debridement.
  • Laser therapy.
  • Surgical removal- incision and complete drainage followed by skin grafting.


Symptoms
Erythema,Oedema,Multiple, interconnected abscesses
suppuration,Pain
Conditions
Hyperkeratosis and follicular occlusion,Dilatation of the pilosebaceous unit,Rupture and release of the follicular contents into the dermis,Formation of abscesses and fistulas,Acne,Diabetes,PCOD,High BMI or obesity
Drugs
Topical antibiotic gels and ointments- clindamycin 1% solution,Oral systemic antibiotics pills, such as tetracycline, doxycycline -Monodox, clindamycin -Cleocin, rifampin -Rimactane or both,Steroid injections- Triamcinolone -Aristospan, Kenalog-10,Hormonal therapy,Cyproterone acetate, an antiandrogen and progestin medication, used by itself or in combination with oral contraceptive pills,Oral retinoids like Acitretin,Pain medication such as lidocaine -Ztlido, nonsteroidal anti-inflammatory drugs -NSAIDs, Acetaminophen -Tylenol and opioids



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