Hidradenitis Suppurativa - Rare Skin Condition

What is Hidradentitis Suppurativa?

Hidradenitis suppurativa is a chronic skin disease that primarily affects areas of the body where apocrine (sweat) glands are found or where two skin surfaces come in contact with each other. It is most likely to appear in armpits, the groin, buttocks, anal area, or under breasts (in women). The disease is characterized by painful lesions that may seep pus and can lead to extensive scarring. Symptoms range from fairly mild to debilitating. It is not contagious, nor is it the result of poor hygiene.

What are the Symptoms of Hidradentitis Suppurativa?

In it’s mildest form, hidradentitis suppurativa resembles acne. There may be some pitting and it may be accompanied by blackheads. If the disease progresses, small boil-like abscess may form that are tender and puss filled. There can be a single abscess or several and the abscess often becomes inflamed. It eventually breaks open allowing the pus to drain. This drainage may be accompanied by a foul odor. The lesions are heal slowly and, once healed, often recur in months or weeks.

Sometimes rather than the pus filled abscesses, there may be small, hard nodules under the surface of the skin. These nodules may be tender and can linger for years.

As the disease progresses, the lesions can become quite large and they are very painful. They open and drain and are very slow to heal. When they do heal, new lesions may begin to form almost immediately. The lesions often occur in clusters and sinuses (or tunnels) develop under the skin connecting the lesions. These tunnels also become inflamed. The unsightly tunnels and large, seeping lesions are very painful. These, as well as the odor sometimes accompanying the draining pus, cause great distress to the sufferer who is often ashamed of the condition. This sometimes causes them to delay getting medical treatment. However, as stated before, Hidradenitis suppurativa is not contagious or the result of poor hygiene and should not reflect poorly on someone suffering from this difficult disease.

How is This Condition Diagnosed?

A physician will diagnose this disease based on symptoms and medical history. While there is not a specific test to diagnose it, the physician may still run blood tests and culture any drainage from a lesion to rule out other conditions.

What Causes or Aggrevates Hidradentitis Suppurativa?

The lesions of Hidradenitis suppurativa are caused when apocrine glands and hair follicles become plugged by the fluid secreted by the apocrine glands plus oil secreted by sebaceous glands and the normal debris created as skin cells die and are cast off. Once blocked, more and more fluids, oil and cells become trapped and begin to press into and irritate surrounding tissues. While bacteria does not cause HS, secondary bacterial infections are common and are the cause of the odor associated with the draining lesions. While both the apocrine gland and the hair follicle becomes blocked, it is not clear which blockage happens first and which causes the other to become plugged. Beyone that, it is not known why these otherwise normal processes cause a blockage in the first place. While not causative, it appears that hormone disfunction, genetics, stress, bacterial infection, excess weight and cigarette smoking may all play a role in aggravating the disease or setting off a flare up.

Who is Most Likely to Get This Disease?

Unfortunately, this is a poorly researched disease and no one can predict who may be striken with it. However we do know that women get it a bit more frequently then men, and African-Americans are slightly more likely to have it than other ethnic groups (in U.S. based research). People with other auto-immune diseases are also more likely than other people to have this condition. Hidradenitis suppurativa is considered an orphan disease, meaning there is little research about it ongoing. Until this situation changes, we are unlikely to get the answers to these questions.

How is Hidradenitis Suppurativa Treated?

Many patients are initially misdiagnosed because the condition is rather rare and most physicians are not very familiar with it. When they are properly diagnosed they may not find relief quickly. There is no single treatment that works for all patients and some patients must persist in trying many different treatments. Mild cases can be treated with home care, such as warm compresses, and by taking care to clean the area regularly with antibacterial soap to prevent secondary infections.

Most often, the first treatment for more severe cases will be antibiotics. Whether this actually improves the HS is unclear, but may be useful to address secondary infections. NSAIDS (non-steroidal anti-inflammatory drugs) such as Advil, may be helpful in reducing inflammation and pain. The physician may try a retinoid medication believing it will inhibit sebaceous gland function and thus minimize the blocking of the apocrine gland. Corticosteroids are sometimes used to try to reduce inflammation. They may be applied topically or injected into the lesion. None of the medical treatments available cure hidradenitis suppurativa. They offer different levels of control and relief of symptoms to different people.

In severe cases surgery may be recommended. This may involve incising and draining individual lesions. Sometimes removing the skin and tissues covering tunnels has proved useful to reduce the time required for the lesions to heal and to reduce scarring. In some extreme cases large areas of affected skin is removed and replaced with grafted skin. In all cases of surgical treatment, the disease may recur, either to the same area or somewhere else.

What Else Can Someone Do to Control Hidradentitis Suppurativa?

Warm compresses are often soothing. A patient should take care to keep affected areas clean and use a topical antibiotic to prevent secondary infections. Avoid activities that will cause skin irritation. Do not shave an affected area or wear tight fitting clothing. Practice good health habits and avoid habits known to increase health risks in general. In particular, it may help reduce symptoms of hidradenitis suppurativa if you eliminate excess weight and stop smoking.