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Hidradenitis Suppurativa

What is Hidradenitis Suppurativa?

Hidradenitis suppurativa is a chronic skin condition, having as main characteristic lumps of different sizes under the skin. Also known as acne inversa, this skin condition appears most commonly in areas where there are sweat glands or where there are skin folds. Appearing shortly after puberty, this skin condition can persist for many years and it can become indeed worse with time. The importance of early diagnosis cannot be subestimated, as this is the best way to manage the symptoms and prevent the appearance of new lesions on the skin.


The lumps that appear under the skin can be as small as a pea and as big as a marble. They are in fact skin abscesses and cysts (epidermoid, sebaceous etc.) that can cluster and form tunnels under the skin, complicating the disease even further. Even though this is a skin condition, it is not at all contagious. The areas that are most affected are the underarms, under the breasts, inner thighs, groin and buttocks. As you can see, these are areas where it is always moist and warm, plus there are plenty of skin folds.

What does Hidradenitis Suppurativa look like?

The way this skin condition looks like depends on the stage. According to Hurley, there are three stages of hidradenitis suppurativa:

  • Stage one – in this stage, the patient presents one or more abscesses on the skin but these are isolated. There is no scarring after the abscess heals and they do not form sinus tracts or tunnels under the skin. There may be inflammation associated.
  • Stage two – in this stage, the patient presents abscesses that are recurrent. These are solitary or multiple and they often lead to the formation of sinus tracts or tunnels under the skin. In this stage, the inflammatory process is more severe, restricting different types of movements and imposing drainage of the said abscesses.
  • Stage three – this is the most serious stage, in which there are extensive and connected lesions, with more than one sinus tract or tunnel under the skin. As a matter of fact, these tunnels become interconnected, complicating the initial problem. There is major inflammation involved, with marble-sized lumps and sometimes even bigger. Scarring is a major risk and so are subcutaneous infections, such as fistulas.

Symptoms of Hidradenitis Suppurativa

These are the most common symptoms of hidradenitis suppurativa:

  • The first lesions might be similar to pimples or boils, they might disappear after a while
  • In later stages, the lesions become more painful and deep, healing, scarring (not always) and then reappearing
  • Once a breakout ruptures, there will be foul smelling liquid coming from it
  • The healing and reappearance process is the one responsible for all the scarring. The more breakouts, the thicker the scars will become
  • Formation of sinus tracts or tunnels under the skin leads to a spongy aspect of the skin
  • Subcutaneous infections with fistulas
  • Cancerour lesions (in rare cases) – this is a risk especially for nodules on the buttocks (squamous cell carcinoma).

Causes

At the present moment, the exact cause of hidradenitis suppurativa has yet to be identified. However, there are several underlying conditions that present an increased risk for the appearance of this skin disease, such as:

  • Puberty – persons reaching puberty present an increased risk of developing hidradenitis suppurativa
  • Immune-deficiency – these patients are susceptible to HS and they will also suffer from secondary infections complicating the disease
  • Hormonal dysfunctions – the moment your hormonal balance is not stable, you stand an increased risk for various medical problems, including HS
  • Clogged skin pores or folliculitis – one of the main areas in which lesions develop is the axilla
  • Excessive sweating – this condition favors the development of HS lesions and it also prevents them from properly healing
  • Genetic disorders – researchers are still trying to make a connection between these and HS but at the moment all they know is that genetic disorders in which the cell structure is altered also present an increased risk for HS

Even if the exact cause of HS is not yet known, scientists have been able to pinpoint factors that might trigger the disease. These are:

  • Obesity – as the lesions appear in areas where the skin rubs, it goes without saying why obesity is a triggering factor
  • Living in a hot and humid environment – it creates a perfect opportunity for HS to appear
  • Oral contraceptives – these modify the hormonal balance and create hormonal dysfunctions
  • Using cosmetics that contain allergenic ingredients – some deodorants clog the skin pores and favor the appearance of HS
  • Tight and synthetic clothing – if the skin doesn’t breathe and there is a lot of friction, then HS feels right at home

Treatment

First of all, you should know that the treatment depends on the stage of the disease and the factors that might have triggered it in the first place. These are the most common courses of treatment undertaken for hidradenitis suppurativa and they should only be followed under the close supervision of a doctor:

  • Antibiotics – as many of these breakouts become infected, a good antibiotic will be necessary to reduce the inflammation and fight off the infection
  • Cortisone injections – these are directly injected in the area of the lesion and they can be very useful for more serious cases. However, this is not a treatment to be administered for prolonged periods of time, as it can have serious side-effects
  • Vitamin supplements – vitamin A is the number one recommendation for skin rejuvenation
  • Hormone therapy for hormonal dysfunction
  • Anti-inflammatory drugs – these can be administered orally or, more recently, at the area of the breakout through infusion (controversial method, not FDA approved)
  • Zinc supplements – these supplements favor the remission of breakouts
  • Antibiotic soap – just as antibiotics, this soap will help to keep the area of infection as clean as you possibly can
  • Topical creams – especially recommended in the situations where HS has been triggered by clogged skin pores or hair folliculitis
  • Retinoids – these are not so effective on HS, the only advantage being that they tend to reduce the severity of a case. However, taken on a long term basis, they can have serious side-effects
  • Radiation – not a common choice of treatment, as it can induce radiation-based tumors.
  • Minimal invasive surgery – incision and drainage of pus-filled abscesses or cysts.
  • Laser hair removal – this is only in the testing phase but it seems that lesions improve after the hair follicle is destroyed.

Apart from the treatment, this disease will require the patient to make some serious lifestyle changes. These are just a few recommendations made available here:

  • Losing weight
  • Eating healthy – fresh fruits and vegetables
  • Drinking plenty of water
  • Avoiding spicy and sugary foods at all costs
  • Applying warm compresses to the breakout areas
  • In case of inflammation, applying cold compresses to the affected areas
  • Stopping smoking
  • Washing with benzoyl peroxide – this has the ability to increase skin turnover, to clear the skin pores and to reduce the bacteria present in the skin.

Is Hidradenitis Suppurativa contagious?

The answer is simply no. Hidradenitis suppurativa is a skin condition that cannot be transmitted to another person. Given the fact that bacteria are not involved in the primary process leading to the appearance of the disease, it goes without saying that this is not an infectious disease. Once a disease is not infectious, it is not contagious either.

How to prevent Hidradenitis Suppurativa?

Often times, preventing the appearance of such a skin condition has to do with the lifestyle changes that were already mentioned above.

  • Eat healthy, drink plenty of water and exercise to lose weight
  • Wear clothes that are made from cotton as they are comfortable
  • Avoid humid and hot climates
  • Use deodorants and other cosmetics that contain only natural ingredients. Refrain from deodorants that prevent sweating all together, clogging the skin pores
  • Lead a stress free life
  • Maintain a good hygiene for the entire body, using anti-bacterial or general antiseptic products

How to get rid of Hidradenitis Suppurativa scars?

These are the most common courses of treatment taken for the elimination of hidradenitis suppurativa scars:

  • Wide-scale removal or excision of the affected area
  • Skin grafts and general plastic surgery
  • Carbon dioxide laser treatment
  • Radiotherapy (not the most common)

Both the skin grafts and the carbon dioxide laser treatments have different results, depending on the stage of the disease and how serious the lesions have extended. Experimental treatments are in the phase of research at the moment, as there are more and more people diagnosed each year with HS and suffering from extensive scarring. The treatment of scars is perhaps one of the most complicated parts of treating HS in general, so, hopefully, these experimental treatments are going to provide patients with the much-needed relief.

Hidradenitis Suppurativa Pictures

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