Hidradinitis suppurativa is a condition that affects the apocrine glands, which is a type of sweat gland, and sometimes oil glands. These become clogged and inflamed which leads to the formation of painful bumps under the skin which can then progress to draining boils or abscesses. These can range in number and size depending on the severity of the condition. The underarms, groin, and buttocks are most commonly affected. In women it can also occur underneath the breasts. These symptoms occur repeatedly and can persist for months. Over time scarring and sinus tracts, or tunnels connecting the abscesses under the skin, may develop.
The cause of hidradenitis suppurativa (HS) is still unknown. Even though the abscesses can become infected, it is not caused by bacteria and is not contagious. It is thought to be caused by an abnormal response of the body’s own immune system. In other words, HS is an autoimmune disease. The immune system is designed to attack outside invaders such as viruses, bacteria, and parasites to protect us from infection. The immune system attacks these by producing inflammation which causes symptoms including redness, pain, swelling, pus, and drainage in order to kill and remove the infection. In the case of HS, however, the body is attacking its own healthy tissue around the apocrine glands.
Other similar conditions that can affect people with HS include a form of severe acne called acne conglobata and dissecting cellulitis of the scalp. Autoimmune diseases tend to occur together, which is why people with HS sometimes also have diabetes, thyroid disease, rheumatoid arthritis, or Crohn’s disease. There also seems to be a genetic link between family members.
No matter what the severity, HS can be very debilitating. Lesions cause pain, pressure, and discomfort that can prevent its sufferers from performing activities of daily life, including exercise. People with HS can become overweight or obese which makes the condition worse. The foul odor and appearance of the lesions may lead to embarrassment and isolation, preventing those with HS from socializing and forming close relationships with others. Depression is common.
There is no test to diagnose someone with HS. The diagnosis is based on history and the pattern of symptoms. HS is often misdiagnosed, and it may take many years before arriving to the correct diagnosis. A doctor specialized in dermatology is best suited for determining if someone has HS.
Acne Inversa-a proposed new term which has not gained popularity
Fox-den disease-not a medical term, but used because it describes the appearance of the sinus tracts which look like deep fox den burrows
Pyodermia fistulans significa-outdated term no longer used today
Velpeau’s disease-after the French surgeon who first described the disease in medical literature in 1833.
Ask yourself these questions:
Have you experienced deep blind lumps under the skin, actively draining abscesses, or scarring?
Do these lesions occur in the armpit, groin, around the anus, or beneath the breasts?
Do these get better eventually, only to reoccur time and time again?
If you answered yes to one of more of the above questions, then you could have HS. It’s time to see a dermatologist.
More research needs to be done to evaluate the cause of HS, but risk factors have been identified some which are controllable but others which are not:
Uncontrollable Risk Factors:
Sex: Women are more likely to have HS than men
Age: HS usually occurs after puberty
Having other autoimmune conditions such as thyroid disease, rheumatoid arthritis, or Crohn’s disease
Hormones-overproduction of androgens (male hormones), monthly cycles in women
Controllable Risk Factors:
Being overweight-HS is not caused by obesity but it can make it worse. Losing weight improves HS but does not cure it.
Heat and humidity
Friction from clothing
Hidradenitis suppurativa is often misdiagnosed as solitary skin abscesses, folliculitis, and bacterial skin infections. Bacterial cultures are often ordered, which are unnecessary because HS is not caused by bacteria. The wrong medications are often prescribed. What is often missed is the “big picture” of the disease which leads to under treatment and lack of preventative care. A dermatologist is specially trained in managing this disorder.
There is no cure or FDA approved treatment for hidradenitis suppurativa. There is also lack of a consistently effective treatment for HS. What may work for one person may not work in another. Treatment is individualized and based on the severity and stage of progression of each case. Your dermatologist is able to assess the severity and stage of your disease and determine what treatments are appropriate for you.
Usually, early mild cases are treated with topical antibiotic creams and washes to prevent infection. If excessive sweating is an issue, you may be prescribed a topical agent which decreases sweating or receive Botox injections. Over the counter NSAIDS such as ibuprofen or naproxen may alleviate pain and inflammation. Long term oral antibiotics are a common treatment of more advanced stages due to their anti-inflammatory effect and to prevent infection. If you have a severely painful lesion at the time of your visit, your doctor may offer an anti-inflammatory injection directly into the lesion or lance and drain it. This quickly relieves pain and discomfort.
For more advanced cases, usually surgery is necessary but recurrences of HS are common. Early, rather than delayed, surgery has been suggested by some experts to be the treatment of choice to prevent further progression of disease and more difficult surgery later on. Other treatment options address the possible hormonal cause of HS, including hormonal contraceptives or finasteride. Oral retinoids which work by lowering oil gland activity helps to reduce inflammation especially before surgery. Corticosteroids and immunosuppressants are other treatment options, but their side effects must be considered.
Reduced pain and discomfort
Better quality of life
Cost varies according to the treatment being offered. Basic treatments such as creams or antibiotics are generally inexpensive. Since no treatment is FDA approved, more expensive treatment options except for surgery may not be covered by health insurance. Financial assistance may be available for some treatments.
Dr. Scannon is a board certified dermatologist with over 30 years of experience treating all types of skin disorders. He acknowledges that there is a void in the appropriate treatment and diligent follow-up of patients with hidradenitis suppurativa. This motivated him to start a hidradenitis clinic. He is supported by well-trained clinical staff and a team of medical and surgical specialists that may be called on when needed.
Hidradenitis Suppurativa Foundation, Inc: www.hs-foundation.org
Hidradenitis Suppurativa Institute: www.hs-institute.com