What is Hidradenitis Suppurativa?
Hidradenitis suppurativa is known as acne inversa. It is a relatively rare condition that involves painful bumps in the hair roots beneath the skin. The bumps can become inflamed or infected. This can result in pus-filled pockets similar to cystic acne. The pockets that form can break open and leave scars.
What is Hidradenitis Suppurativa caused by?
The exact cause of hidradenitis suppurativa is not fully known. Studies do indicate that women develop this condition more than men and that it sometimes runs in families. This suggests some degree of genetic involvement. The symptoms of Hidradenitis Suppurativa are a result of the inflammation and infection that occurs near a sweat gland or hair root. Some researchers theorize that abnormal gland development could be a contributing cause of hidradenitis suppurativa.
It is important to note that hidradenitis suppurativa is not a hygiene issue. It is not caused by lack of adequate bathing nor by the use of powder or deodorant, nor by shaving the underarms. It is not contagious.
What are the Symptoms of Hidradenitis Suppurativa?
Hidradenitis suppurativa often affects the sweat glands, resulting in recurring bumps in areas such as the scalp, breasts, underarms, groin, and genital or anal regions. Bumps usually begin to appear sometime during puberty or early adulthood. Rarely do cases occur after age 40. Hidradenitis suppurativa is a chronic condition that has times of remission followed by flare-ups. Flare-ups can be triggered by heat and perspiration, hormones, stress, weight gain, and menstruation.
There are 3 clinical stages of hidradenitis suppurativa. Each may bring certain symptoms. These include:
- Hurley stage 1: Early symptoms such as itching or discomfort may occur before bumps are seen or felt.
- Hurley stage 2: Single or multiple widely separated lesions form, along with recurrent abscesses and scarring.
- Hurley stage 3: Multiple interconnected tracts and abscesses can be seen across the entire affected area.
Obstruction can lead to follicular rupture, causing painful nodules beneath the skin. Abscesses are pus-filled infected cysts which can also rupture through the skin. The fluid may have an unpleasant odor. As the ruptured lesions heal, scar tissue forms.
What Treatment Options are Available for Hidradenitis Suppurativa?
There is no cure for hidradenitis suppurativa. The goal of treatment and lifestyle changes is to reduce flare-ups and keep the skin as healthy and attractive as possible. Treatment for this condition is determined based on which stage it is in. It may be necessary to try more than one treatment option to find which is most effective. Lifestyle changes can enhance the results achieved through personal medical care.
Hidradenitis suppurativa may be managed with:
- Warm compresses applied to mild symptoms.
- Over-the-counter nonsteroidal anti-inflammatory drugs such as ibuprofen or aspirin may be taken to manage swelling and inflammation.
- Antibiotics may be prescribed to use topically or take orally as a way to fight infection. These may be needed for a few months.
- Corticosteroid injections may be administered into bumps to rapidly decrease swelling, pain, and inflammation.
- Oral acne medication. Accutane is an example of an oral retinoid that may be prescribed to reduce more severe symptoms.
- Metformin is another oral medication that may be used to treat hidradenitis suppurativa. This is normally prescribed to help manage diabetes but has shown good results in HS patients.
- Psoriasis medication may help control the inflammation caused by hidradenitis suppurativa.
- Topical resorcinol may be used to help maintain optimal cellular turnover, reducing blockages and inflammation.
- Hormone therapy such as birth control pills can help reduce symptoms in some women.
- Injected biologics such as Humira or Remicade may be administered in more severe cases.
Sometimes, surgery is needed to do one of a few things. Surgery may be performed to drain painful pus-filled bumps to relieve discomfort. A procedure called deroofing may be performed to stop recurring bumps by turning them into painless scars. Some doctors perform skin removal and grafting to try and achieve longer-lasting improvement. Another option for clearing new bumps that form deeper beneath the skin is to perform laser surgery that destroys the hair follicles.
When Should I See a Doctor for Hidradenitis Suppurativa?
Hidradenitis suppurativa can persist for years and cause physical and emotional pain. If you are experiencing recurring, uncomfortable bumps beneath your skin, schedule a consultation with a board-certified dermatologist. A doctor can conduct a comprehensive consultation and examination that discerns how long symptoms have been going on, how painful the bumps are, where they are located, and whether or not anyone in your family has experienced similar symptoms. Dermatologists are trained to diagnose and treat hundreds of skin diseases and conditions. With personal information from you and an examination of your skin, your doctor can make an accurate diagnosis.
It is important to receive adequate care for hidradenitis suppurativa. Without proper management, this condition can lead to chronic abscesses, severe scarring the minimizes mobility in the affected area, fistulas beneath the skin, lymph node problems, depression and social isolation, and squamous cell carcinoma.