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Hidradenitis Suppurativa - Definition, Causes, Symptoms and Treatment


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Hidradenitis suppurativa is a chronic disease of the apocrine glands. It is also known as Ďacne inversa'. It commonly occurs on apocrine sweat gland-bearing skin such as in the groin, the underarms and under the breasts. Hidradenitis suppurativa is characterised by recurrent boil-like lumps (abscesses) that culminate in pus-like discharge, difficult-to-heal open wounds and scarring. Women are affected by hidradenitis suppurativa three times as often as men; the reason for this is unknown. The condition most commonly occurs between 20-40 years and coincides with the post-pubertal increase in androgen levels. Disease onset rarely occurs before puberty and after menopause. It is similar to acne, which is also a disease of the sebaceous glands. It may be an unusual type of adult acne. Bacterial infection produces the pain and odor. Hidradenitis is made worse by being overweight, however this condition is not caused by obesity and weight loss will improve but not cure hidradenitis.

Hidradenitis suppurativa affects people who are extremely overweight at a higher rate than the general population. Females are more likely to develop this disease than males. Hidradenitis is more common in people who have had acne. Cigarette smokers also have a higher incidence of this disorder than nonsmokers. Pain is a common symptom in chronic disease. Over time, fibers of scar tissue branch out, creating restrictive, tight skin. This can interfere with movement of the arms or legs, if the sweat glands in the armpits or groin are involved. Medical management of hidradenitis suppurativa is difficult. The aim is to catch the disease in its early stages and treat and control these milder forms. Weight loss in obese patients and smoking cessation are recommended. Surgery is the most effective treatment for hidradenitis. Aggressive surgery will cure an area of severe, chronic hidradenitis but it has to remove scarred tissue or even large areas of skin.

Causes of Hidradenitis suppurativa

The exact cause of hidradenitis suppurativa remains unclear. What is understood is that the condition is a disorder of follicular occlusion. This begins with follicular plugging that obstructs the apocrine gland ducts and perifolliculitis around the ducts. There seems to be a genetic predisposition for the disease, and it seems to be more common in women. Hidradenitis suppurative does not appear in people who have not reached puberty because the sweat glands are not active, but it can appear at any age afterward. Cigarette smokers also have a higher incidence of this disorder than nonsmokers.

Common causes and risk factors of Hidradenitis suppurativa:

  • Enlargement in the sweat glands.
  • Cigarette Smoking.
  • Stress and the onset of the menstrual period.
  • Individuals with tightly curled hair.
  • Extreme heat or excessive perspiration.

Signs and Symptoms of Hidradenitis suppurativa

Signs of this disease are firm red nodules that are usually located under the arm, in the groin, around the breasts, or around the anus. Pustules and abscesses may discharge pus spontaneously and heal slowly, resulting in scar tissue. If uncontrolled, this leads to development of larger lesions, sinus tract formation, and involvement of multiple sites. Disease may spread to involve less commonly associated sites including the nape of the neck, waistband and inner thighs. Anogenital involvement most commonly affects the groin, mons pubis, vulva, sides of the scrotum, perineum, buttocks and perianal folds. The abscesses and sinus tracts can be painful.

Sign and symptoms may include the following :

  • Tunnels that form under the skin between abscesses.
  • The inflammation of single or multiple areas and pus may be seen, which looks like acne.
  • Hard lumps under the skin that are very painful to the touch.
  • Scarring.
  • Painful, rounded deep-rooted inflamed lumps.

Treatment for Hidradenitis suppurativa

Treating hidradenitis suppurativa is difficult. It is best treated in the early stages before extensive scarring develops. However, it must be diagnosed correctly. For mild to moderate cases, dermatologists first attempt therapy topically, such as with topical retinoid. Simple cases can be treated with moist heat or incision and drainage of the abscesses. In severe cases, surgical removal of scarred skin and underlying diseased tissues may be the only alternative. These areas are often left to heal without skin grafting. In severe cases, cutting out the involved area followed by skin grafting may be necessary.

Treatment may include:

  • Topical Antibiotics are one of the best treatment option for curing hidradenitis suppurativa fast.
  • Contraceptive Pills and the combination of estrogens with 100 mg of cyproterone acetate have been used.
  • Systemic Antibiotics are necessary when the condition is flaring or when a patient is undergoing a severe case of hidradenitis suppurativa.
  • Sometimes surgery is required to drain infected areas or to remove scarred tissue or even large areas of skin.
  • High-dose systemic steroids are useful as adjuvant's to antibiotics, and they act by reducing the inflammatory process.