Summary about Disease
Suppurative hidradenitis (HS), also known as acne inversa, is a chronic inflammatory skin disease characterized by painful, recurring boils and nodules, often accompanied by scarring, primarily in areas where skin rubs together, such as the armpits, groin, buttocks, and under the breasts. It is a long-term condition with periods of flare-ups and remission.
Symptoms
Painful bumps that resemble pimples or boils, often deep under the skin.
Blackheads, often in pairs or groups.
Pain, itching, and burning in affected areas.
Abscesses that drain pus and may have an odor.
Tunnels under the skin (sinus tracts) that connect the abscesses.
Scarring, often thick and rope-like, in areas where lesions have healed.
Causes
The exact cause of HS is unknown, but it is thought to be a combination of genetic and environmental factors. It is not caused by poor hygiene. Factors that may contribute include:
Genetics: HS tends to run in families.
Hormones: Hormonal changes, such as puberty, menstruation, and menopause, may play a role.
Immune System: An abnormal immune response may contribute to inflammation.
Smoking: Smoking is a significant risk factor.
Obesity: Being overweight or obese can worsen HS.
Hair Follicle Issues: Blockage and inflammation of hair follicles are thought to be involved.
Medicine Used
Treatment for HS depends on the severity of the condition and can include:
Topical Treatments: Antibiotics (clindamycin), antiseptic washes (chlorhexidine), and retinoids.
Oral Antibiotics: Tetracycline, doxycycline, clindamycin, or rifampin.
Pain Relievers: Over-the-counter or prescription pain medications.
Hormone Therapy: Birth control pills (for women) or anti-androgen medications.
Biologic Medications: Adalimumab (Humira) is the only FDA-approved biologic for HS. Other biologics, such as infliximab, may be used off-label.
Retinoids: Acitretin or isotretinoin (less effective than for acne).
Surgery: Incision and drainage, wide excision, deroofing, or laser surgery may be used to remove or reduce affected tissue.
Corticosteroid injections: Used for inflammation.
Is Communicable
No, suppurative hidradenitis is not contagious. It is not caused by a virus, bacteria, or fungus that can be spread to others.
Precautions
Maintain good hygiene: Gently wash affected areas with a mild, antibacterial soap.
Avoid tight clothing: Wear loose-fitting clothing to reduce friction.
Maintain a healthy weight: Obesity can worsen HS.
Stop smoking: Smoking is a significant risk factor.
Avoid shaving: Consider laser hair removal or trimming hair instead of shaving affected areas.
Manage stress: Stress can trigger flare-ups.
Stay cool and dry: Avoid excessive sweating and keep affected areas dry.
Consult a dermatologist: Follow your doctor's treatment plan and attend follow-up appointments.
Consider dietary changes: Some people have found certain dietary changes have helped their symptoms.
How long does an outbreak last?
HS is a chronic condition, so there isn't a single "outbreak" length. Instead, individuals experience flare-ups (periods of active symptoms) that can last for days, weeks, or even months. Between flare-ups, there may be periods of remission (little to no symptoms). The duration of flare-ups and remissions varies greatly from person to person.
How is it diagnosed?
Diagnosis is typically based on:
Physical Examination: A doctor will examine the affected areas and look for characteristic lesions, such as nodules, abscesses, and sinus tracts.
Medical History: The doctor will ask about your symptoms, family history, and other relevant medical information.
Ruling out other conditions: The doctor may perform tests to rule out other conditions that can cause similar symptoms, such as boils or carbuncles. This is usually done through visual examination; biopsies are sometimes taken.
No specific blood test confirms HS.
Timeline of Symptoms
HS typically progresses through stages, but the timeline can vary:
Early Stages: May start with a single or a few small, pimple-like bumps that are often mistaken for boils. These may be itchy, painful, or drain pus.
Intermediate Stages: More bumps develop, and they may connect under the skin via sinus tracts. Pain and inflammation increase. Scarring begins to appear.
Advanced Stages: Multiple, interconnected abscesses and sinus tracts are present. Significant pain, drainage, and scarring occur. Movement may be limited due to pain and tissue damage.
Important Considerations
Impact on Quality of Life: HS can significantly impact a person's quality of life, leading to pain, discomfort, social isolation, and psychological distress.
Early Diagnosis is Key: Early diagnosis and treatment can help prevent the disease from progressing and minimize complications.
Individualized Treatment: Treatment plans should be tailored to the individual's specific needs and the severity of their condition.
Long-Term Management: HS is a chronic condition that requires ongoing management, even during periods of remission.
Potential Complications: Complications can include scarring, lymphedema, skin infections, anemia, and rarely, squamous cell carcinoma.
Support Groups: Support groups can provide valuable emotional support and connect individuals with others who understand what they are going through.