Hidradenitis Suppurativa (HS)

Everybody has apocrine glands - they are commonly called sweat glands and are found only in certain locations of the body: the armpits, the areola of the nipples, and the genitoanal area of the body. The ducts of the apocrine glands open into the canals of hair follicles and the secretion of these glands is adrenaline - a hormone that is carried in the blood.

So, what do sweat glands have to do with boils?

There is a chronic condition that affects the same areas of the body in which the apocrine glands are located and it manifests with boil-like lesions that are painful and hard to get rid of. The condition is known as hidrandenitis suppurativa (HS). The exact cause of this condition is still unknown, however, what is know is that it occurs when apocrine gland outlets become blocked by perspiration making it difficult for the gland to drain. Secretions trapped in the glands force perspiration and bacteria into the surface tissue surrounding the glands causing boil-like eruptions. It is often found in people who also suffer with acne, pilondial cysts, and chronic scalp folliculitis.

Who Gets HS and Who Doesn't?

There are some possible factors that play into who will have HS and who won't. Genetics may have a bearing because those who do suffer with HS frequently have other family members who deal with it as well. The hormones androgen and estrogen are also considerations since the apocrine glands are stimulated by these hormones as well as adrenaline. Women are more affected than men are with HS and it is common to find women with HS also confronted with acne, hirsutism and obesity - all of which are considered endocrine factors. Cigarette smokers have a higher frequency of hidradenitis suppurativa than non-smokers. HS has also been linked to auto-immune diseases, where there is an overreaction by the immune system against substances within the body. In other words, the body turns on itself and attacks its own cells. As is common with many skin problems, it becomes worse with heightened stress levels.

How Hidrandenitis Suppurativa Presents Itself

Hidrandenitis Suppurativa presents in three clinical stages. Stage one is the forming of single or multiple abscesses, without sinus tracts and scar formation. In the second stage, the abscesses recur with sinus tract formation and scarring. There may be single or multiple lesions that are widely separated. Stage three appears as many lesions and abscesses that are interconnected through the sinus tracts and the involvement is broad in the area affected.

It is interesting to note that as many as 80% of people who suffer with hidrandenitis suppurativa are also diagnosed as clinically depressed. People who live with chronic pain tend to become depressed and although the condition can be treated with medication, in order to be rid of the depression a cause must be dealt with. Unfortunately, there is no cure for HS at this time, which means depression is part of the cycle.

Diagnosing HS

Anyone who has more than three boils in a year should check in with their physician. Boils can be a symptom of a number of illnesses for which a person should be tested. Generally, the diagnosis for HS comes from a dermatologist who can determine the condition through observing the areas where the boil-like lesions are, and the common presence of black heads and scarring that go along with it.

Treatment Requires Research

Since there is no single treatment developed for HS at this point, it is important that the sufferer is involved in choosing the treatment and researching what is available. Even though HS is not acne, the symptoms present in a similar fashion. Consequently, acne treatments have been used to treat HS, will no effective responses. Other treatments include the long term use of antibiotics like tetracyclines as a preventive measure and ciprofloxicillin for the short term secondary infections. Many of these antibiotics react badly with sunlight and alcohol, and can also cause nausea and bowel problems. Systemic steroids have been used in high doses and birth control pills are used in a bid to balance hormones. Retinoids have not proven very effective either.

Surgery and Radiotherapy - Options for Treatment

Surgical treatments like incision and draining, removal of recurring lesions and even plastic surgery are prescribed. Recently radiotherapy has been reintroduced as a way of treating HS and the reports in a study by Frochlich et al in Germany show very encouraging results. There were no reported complications and the improvement was dramatic for nearly 80% of people using this form of treatment.