Hidradenitis Suppurativa

What Is Hidradenitis Suppurativa?

Usually beginning after puberty, when oil and sweat glands begin to mature and hair begins to appear on the body, hidrandenitis suppurativa (HS) can persist for years and tends to worsen over time. A chronic skin inflammation, HS is identified by blackheads-usually two beside each other giving a shotgun appearance-and one or more lesions that are red and painful. The bumps or lesions grow and then burst,draining pus and often leaving scars in their wake. The condition also may manifest with painful, pea-sized lumps which eventually become hard and can enlarge and be very sore. Open sores or bumps that weep are also characteristic of HS. It is considered to be a severe form of acne and generally occurs in the groin, armpits and in places where skin rubs together such as under the breasts or inside the thighs. Some of these areas are also the main locations of apocrine sweat glands, which makes the areas more susceptible to inflammation.

How Does It Happen?

The inflammation occurs around oil glands, apocrine sweat glands, and hair follicles. Dead skin, moisture from the glands and other debris are washed into the hair follicles where oil mixes with it. When the follicle openings become blocked from the collection of debris and oil, then HS happens. The mixture is trapped in the follicle and, since it cannot escape, it pushes out into the surrounding tissue. Bacteria, which is present on the skin, triggers an infection and the accompanying inflammation.

Risks And Complications

There does not seem to be one single explanation for this condition. However, several factors are implicated in its development. Hormones, genetics (someone in the family with the condition), being overweight and cigarette smoking are all possibilities. Other diseases may trigger the outbreak as well. Crohn's disease, Grave's disease and herpes simplex are sometimes accompanied by HS. This condition can happen to anybody, yet it seems women tend to get it more than men. There is no explanation for this, either. It is most often seen in people between the ages of puberty and 40, although sometimes it does occur in people over 40. Rarely are children affected.

Should HS become severe and persistent, there are some complications which may be present. Tunnels, called sinus tracts, are sometimes formed under the skin and they often slow the healing process and can create more sores and pimples. Thick, raised scars or pitted skin that seems to be stained darker than the surrounding skin are also problems that arise. The pain from the infections can be so severe that movement is restricted and a potentially serious skin condition called cellulitis can eventually spread to the lymph nodes and bloodstream if left unchecked.

Diagnosis And Treatment Options

Diagnosis of hidradenitis suppurativa is established through a skin culture to rule out other skin conditions such as pilonidal cysts or carbuncles. Early treatment to manage new lesions and halt the growth of more is the first line of defense. Since no cure is available for HS, the treatment must be established in accordance with the current state of the condition. Antibiotics, oral retinoid medications, NSAIDs, corticosteroids, or immunosuppressant drugs are all considerations. If the condition is very severe and the lesions are deep, then surgery may be suggested. Incision and draining, as with boils, is one form of surgical treatment. The removal of all skin and tissue around the inflamed area and performing a skin graft is another. A third is the opening of the tunnels to drain and dry out. However, none of these surgical measures guarantees the condition will not return.