Hidradenitis Suppurativa — Know It All!
All you need to know about Acne Inversa.
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Hidradenitis Suppurativa is also known as Acne Inversa.
Hidradenitis suppurativa, also known as acne inversa, is a chronic, non-contagious, inflammatory disease with pimple-like bumps or boils and tunnels or tracts on and below the skin. With persistent drainage, pus-filled bumps on the skin or hard bumps below the skin can progress to painful, inflamed areas (also called “lesions”).
HS begins in skin hair follicle. The cause of the disease is unknown in most cases, but a combination of genetic, hormonal, and environmental factors are likely to play a role in its development. The disorder may have a major effect on the quality of life of an individual.
The blockages usually happen in areas where you have hair or where your skin rubs together, such as:
- Under your arms
- In your groin
- Between your buttocks
- Between your thighs
- Under your breasts
- In the folds of your stomach
- On the nape of your neck
- Behind your ears
HS is divided into three stages, based on how severe it is, called Hurley stages.
- Hurley stage I: A single bump with no sinus tracts
- Hurley stage II: More than one bump but little tunneling
- Hurley stage III: Multiple bumps with a lot of sinus tracts and scars, involving an entire area of your body
Symptoms of Hidradenitis Suppurativa :
The symptoms of suppurativa hidradenitis range from mild to severe.
It causes a mixture of boil-like lumps, blackheads, cysts, scarring and pus-leaking channels in the skin.
Hidradenitis suppurativa can cause fleshy lumps to grow on the surface of the skin
Sometimes, narrow channels (sinus tracts) form under the skin, which can break out on the surface and leak pus
The condition appears to begin with a firm pea-sized lump, formed in 1 position. This will either vanish or burst after a few hours or days, and ooze pus.
New lumps then form frequently in a nearby field. If the medication does not regulate these, larger lumps may form and spread. Narrow channels also form under the skin, called sinus tracts, which break out on the surface and leak pus.
Hidradenitis suppurativa is an extremely painful disease. The lumps form in the areas below on the skin:
- around the groin and genitals
- in the armpits
- on the bottom and around the anus
- below the breasts
Also the abscesses can spread to the neck nape, waistband and inner thighs. Some specific areas considered to be affected include the front or rear of the legs, the feet, the back and the face.
Any of the lumps may get infected with bacteria , causing a secondary infection that will require antibiotic treatment. Many people with suppurativa hydradenitis often develop a pilonid sinus which is a small hole or “tunnel” in the skin.
Causes of Hidradenitis Suppurativa :
The exact cause of suppurativa hidradenitis is unclear, but it is due to blocked hair follicles that the lumps form.
Smoking and obesity are also closely correlated with suppurativa hydradenitis, and if you are obese and/or drink the symptoms can get worse.
Hidradenitis suppurativa typically begins around puberty, but can happen at any age. Before puberty and after menopause, it is less normal which may suggest that sex hormones play a role. Often many individuals with the disorder have acne and excessive growth of hair (hirsutism).
Hidradenitis suppurativa may, in rare cases, be related to Crohn’s disease, particularly if it occurs around the groyne area and skin near the anus. Crohn’s disease is a long lasting illness that causes inflammation of the lining of the digestive system.
In around a third of all cases, hidradenitis suppurativa occurs within families. It is not infectious, and is not associated with poor hygiene.
Who Develops this disease?
Hidradenitis suppurativa affects for every man an estimated three women, and is more common in African Americans than in whites. HS also shows up during puberty.
Having a family member with the illness raises the risk of HS growth. An approximate one third of HS sufferers have a parent with the disease.
Smoking and obesity tend to raise the risk of developing HS. People who are obese appear to have more serious symptoms. Can’t spread the disease from one person to another. Weak personal hygiene isn’t causing HS.
HS that is severe or isn’t treated can have complications over time, including:
- Deep pockets of infection (abscesses)
- Trouble moving because of scar tissue
- Hollow passages inside your body (fistulas)
- Lymph node problems
- A skin cancer called squamous cell carcinoma
- Depression and isolation
How to diagnose:
Early diagnosis and treatment of suppurativa hydradenitis is necessary both to control symptoms and to minimise the production of new lesions. Often physicians will diagnose the disorder by testing the skin for boils in areas typical of the disease. Laboratory fluid tests from the lumps and blood tests can be conducted periodically to rule out other conditions.
Hidradenitis suppurativa is a recurring, lifelong condition requiring constant management and often difficult to manage.
Recognizing and diagnosing the disease in its early stages is important to keep it from getting worse.
Treatment for suppurativa hidradenitis will be individually tailored. He may be regulated with medication in the early stages. Operation may be appropriate in serious or chronic cases. Following are the therapies outlined for treatment of HS:
If you have particularly painful, inflamed and oozing pus lumps, a 1- or 2-week course of antibiotic tablets may be recommended, as you may have an infection. However, a secondary bacterial infection is not that common in hidradenitis suppurativa, so you should take a swab of the affected area.
Low doses of antibiotics can be used to avoid inflammation when bacterial infection is not present. This longer antibiotic course would last at least three months, with the goal of reducing the amount of lumps that grow.
Antibiotics may be offered as a (topical) cream or as a tablet , capsule, or liquid that you drink. These forms of antibiotics may include erythromycin, lymecycline, doxycycline, and tetracycline.
A combination of clindamycin and rifampicin can be useful in serious cases of hidradenitis suppurativa but these antibiotics are typically administered by dermatologists rather than GPs.
Antiseptic washes, such as 4 percent chlorhexidine, are also used with other medications applied regularly to the infected areas.
Retinoids, including isotretinoin, and acitretin, are medicines dependent on vitamin A. They are not as effective in treating suppurativa hidradenitis as they are in treating acne, but they can benefit certain people.
Dermatologists often recommend the retinoids. They have to be used carefully and can not be used during pregnancy.
If hidradenitis suppurativa flares up within a period of time, you can benefit from taking the contraceptive pill together.
Immunosuppressive treatments (infliximab and adalimumab)
Treatments that suppress the immune system, such as adalimumab (a biological therapy), can be effective in very serious cases of hidradenitis suppurativa.
There are risks associated with suppressing the immune system, however, so they are typically recommended by a dermatologist only when other therapies don’t work.
Infliximab and adalimumab are immunosuppressive drugs that are administered at regular intervals, either at home or in hospital, by injection.
Rarely, steroids, such as prednisolone, can be used to relieve chronically inflamed skin. You may take steroids as pills, or have an injection directly into the affected skin. Potential steroid side effects include weight gain, poor sleep and mood swings.
If your bumps grow deep into your skin you might have an operation. If in a small area you have problems, your doctor can cut open pockets to drain the pus. This gives you comfort for the short term.
Your doctor turns hard, painful bumps and bruises into wounds that will not hurt, in a process called deroofing. If you have painful bumps that come back over and over again, this is an alternative.
Another form of surgery involves cutting skin at the spots of the problem. Your doctor will do a skin-graft afterwards. They take skin from another part of the body and use it to cover the area where the procedure was taking place.
Other method for removing fresh, deep bumps is laser surgery. It kills the hair follicles, the shafts where hair develops in your skin. Maybe you need several treatments.
Surgery may help with persistent or serious HS cases but it can come back in the same region or somewhere else for certain people.
Coping with the disease:
In addition to treatment prescribed by a doctor, people can do several things on their own to be more comfortable and, in some cases, minimize lesions. These include:
- Keep areas clean, using ordinary soaps and antiseptics.
- Maintain a healthy weight.
- Quit smoking.
- Wear comfortable clothes.
- Use warm compresses.
- Ask your doctor if bleach baths are right for you.
Some people with suppurative hydradenitis find it helpful to collaborate with a mental health provider or to engage in a support group for patients. Other techniques, such as yoga and meditation, can also lead to improving the quality of life in the sick.
Gopala Krishna Varshith,
Content Developer & Editor,