What is hidradenitis suppurativa?
Hidradenitis suppurativa is a chronic inflammatory skin disease involving the hair follicles and sweat glands. Also known as acne inversa, this condition usually begins with the appearance of pimple-like bumps on the skin. Without treatment, these bumps can worsen, grow deep into the skin and turn into painful hard lumps or pockets of pus (boils). The pockets often break open. After they heal, thick scars often form.
Where does hidradenitis suppurativa occur?
Hidradenitis suppurativa typically affects areas of the body where skin touches skin. These areas may include the underarms, buttocks, breasts, and groin (genitals and around the anus), and the inner thigh.
Who gets hidradenitis suppurativa?
Hidradenitis suppurativa affects between 1% to 4% of people in the U.S. It is more commonly seen in females than males. Hidradenitis suppurativa is typically seen in young people, starting at puberty (around 11 years of age) up to about age 40. It is also more common people who are Black, have overweight or obesity and people who smoke.
Symptoms and Causes
What causes hidradenitis suppurativa?
The skin bumps seen with hidradenitis suppurativa occur when hair follicles and/or sweat glands become clogged and inflamed due to abnormal overgrowth of cells. This overgrowth is thought to be secondary to hormones and/or nicotine. After becoming blocked, these structures then rupture causing increased local inflammation and scarring. Hidradenitis suppurativa is not contagious, sexually transmitted, or caused by poor hygiene.
Doctors do not know what causes some people to develop this disease. Researchers are investigating whether hidradenitis suppurativa is genetic (passed down among family members). Sex hormones are also thought to be a possible cause since many cases of hidradenitis suppurativa begin to be seen at puberty.
People with hidradenitis suppurativa often have other medical issues in common. These conditions include:
- Heart disease.
- Dissecting cellulitis (severe patchy hair loss on the scalp).
- Inflammatory bowel diseases (some, like Crohn’s, have skin symptoms that mimic hidradenitis suppurativa).
- Polycystic ovarian syndrome (hormonal disorder in women).
- High body mass index (having overweight or obesity).
What are the symptoms of hidradenitis suppurativa?
When it first develops, hidradenitis suppurativa can have symptoms that range from mild itching and discomfort to the appearance of a red, tender, and swollen areas. Pimple- and/or boil-like bumps appear and can grow, fill with pus, and then break open. The pus that drains sometimes has a foul odor due to the presence of bacteria. Healing of the bumps can cause scarring. Symptoms vary from person to person.
In some patients, the breakouts can reoccur in the exact spot; in others, breakouts occur in the same area but not in the exact same spot. Some people have constant breakouts on their skin; in others, scars are the only sign present at that point in time.
Diagnosis and Tests
How is hidradenitis suppurativa diagnosed?
To diagnose hidradenitis suppurativa, a dermatologist (a doctor specializing in skin disorders) will:
- Ask you about your family history of skin problems.
- Do a physical exam.
- Closely study the appearance of your skin.
- Note where the bumps are located.
- Ask how long the bumps have been present and if they disappear and reappear.
Blood tests can help confirm a diagnosis of hidradenitis suppurativa. If pus is present, your doctor may also take a biopsy (a skin sample) of it to rule out other skin conditions.
Management and Treatment
How is hidradenitis suppurativa treated?
Although there is no cure for hidradenitis suppurativa, early diagnosis and treatment help prevent the disease from getting worse and forming additional scars. Symptoms appear and disappear and vary from person to person. Many treatments are available and usually a combination of the following treatments is tried. Treatment choice depends on the severity of hidradenitis suppurativa.
Initial treatments for mild disease may involve home remedies including:
- Sit in a warm bath and/or apply warm compresses to the affected area for 10 minutes at a time.
- Apply topical cleansing agents, including antibacterial soaps, antiseptics, and acne washes to reduce/kill bacteria.
- Take anti-inflammatory medications, such as ibuprofen (Advil®, Motrin®), naproxen (Aleve®), and celecoxib (Celebrex®).
- Wear loose-fitting clothing to prevent rubbing against the skin.
- Maintain a weight that's healthy for you. Having extra weight causes more friction on the skin in the areas affected by this condition.
When painful skin lesions are present (moderate disease), treatments may include:
- Corticosteroids, such as prednisone, to reduce pain and swelling.
- Anti-inflammatories, such as ibuprofen (Advil®, Motrin®), naproxen (Aleve®), and celecoxib (Celebrex®).
- Antibiotics, such as tetracycline, erythromycin, minocycline and amoxicillin/clavulanate potassium. An erythromycin-based skin cream is also sometimes prescribed. These are used to treat infected lesions.
- Adalimumab (Humira®), a tumor necrosis factor alpha inhibitor, is the first biologic agent approved by the Food and Drug Administration to treat moderate to severe hidradenitis suppurativa.
- Other medications that can be tried include retinoids (acne-fighting drugs) and birth control pills (to address the hormonal cause of hidradenitis suppurativa).
Severe cases of hidradenitis suppurativa are treated using the following surgical procedures:
- Laser. A laser is used to clear new and deep seated breakouts.
- Deroofing. Breakouts are turned into scar tissue (a procedure called deroofing).
- Draining abscesses. Abscesses can be drained to provide some relief.
- Excision (cutting out) of the lesions and skin grafting. In this type of surgery, larger areas of the skin and scar tissue are removed. A skin graft from a healthy area of the body may be needed to replace the lost skin.
What are the complications of hidradenitis suppurativa?
Hidradenitis suppurativa occurs in cycles throughout a patient’s lifetime, with periods of breakouts and healings. In some cases, the disease progresses and causes abscesses (pus-containing areas of infection) to form deep within skin tissue. Continued healing and scarring can cause that area of the skin to become thick and in extreme cases, the scarring makes the affected area firm and difficult to move. Continued healing and scarring can also cause fistulas to form inside the body. Fistulas are hollow passages that are painful and require surgery to repair.
What are the outcomes after treatment for people with hidradenitis suppurativa?
Some people with the disease have recurrent outbreaks for the rest of their lives. Some people who treat the disease early with surgery have no further symptoms. In rare cases, hidradenitis suppurativa clears up without any treatment.
Can hidradenitis suppurativa be prevented?
Because doctors do not know what causes hidradenitis suppurativa, there is no known way to prevent it. However, there are some simple steps that can be taken at home to lessen the symptoms of hidradenitis suppurativa. These include:
- Work to maintain a weight that's healthy for you.
- Wear loose-fitting clothes.
- Take warm baths.
- Do not shave affected areas.
- Clean affected areas daily with antibacterial soap.
- Avoid smoking.
Outlook / Prognosis
What is the outlook for people with hidradenitis suppurativa?
No known cure exists for hidradenitis suppurativa. The outlook (prognosis) depends on the severity of the disease.
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