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Hidradenitis suppurativa is a chronic skin condition which affects areas of the body bearing apocrine sweat glands or sebaceous glands, such as the underarms, inner thighs, groin, buttocks and breasts.
It is characterized by clusters of abscesses in these areas. The abscesses may start off as small pea-sized nodules (sometimes being confused as acne). These lesions may resolve spontaneously or may rupture and ooze pus-like discharge. Sometimes, these abscesses can grow to a very large size, requiring surgical drainage.
These may heal over time, but only to have new ones develop in adjacent areas. These chronically developing abscesses result in fibrosis and scarring, as well as fistula formation. Fibrosis and scar formation can occasionally be severe enough to result in contractions and reduced mobility. Fistulae refer to abnormal tracts that develop between 2 epithelium lined organs. For instance, in anogenital hidradenitis suppurativa, fistulae may develop connecting the anus to the skin. The presence of these fistulae result in chronic discharge and non-healing infections.
What Causes Hidradenitis Suppurativa?
The exact cause of Hidradenitis suppurativa is disputed. However, potential causes include:
• Genetic predisposition
• Plugged sweat glands or hair follicles
• Androgen dysfunction
• Excessive sweating
• Bacterial infections
• Possible link to conditions such as Hashimoto's thyroiditis, Crohn's disease, squamous cell carcinoma and rheumatoid arthritis.
What Are The Possible Triggers?
There are certain triggers for hidradenitis suppurativa which should be avoided. These include:
• Obesity
• Tight clothing
• Excessive sweating, hot and humid environments
• Use of deodorants, shaving and epilation of the affected areas
• Smoking
• Drugs, such as oral contraceptives
How is Hidradenitis Suppurativa Treated?
There is no cure for hidradenitis suppurativa, and management is generally aimed at avoiding triggers and treating acute flares.
The kind of treatment required depends on the severity and extent of the condition. Mild cases may only require self-care measures, such as warm compress and frequent washings with anti-bacterial soaps. Moderate cases may require topical and oral medication prescribed by a doctor or dermatologist.
Medication may include:
• Antibiotics - to treat more infections and prevent further outbreaks
• Non-steroidal anti-inflammatory drugs (NSAIDS) to manage pain and inflammation
• Oral retinoids help to stop oil production from the oil glands and help prevent plugging of the hair follicles
• Tumour necrosis factor (TNF) alpha inhibitors - these drugs have shown some promise in the treatment of this condition
For more severe or persistent cases of hidradenitis suppurativa, surgery may be necessary. These may include:
• Incision and drainage of abscesses
• Fistulectomy - this refers to uncovering and laying open of fistula tracts
• Surgical removal of all involved skin followed by closure with skin flaps or skin grafts
Find a Dermatologist
The article above is meant to provide general information and does not replace a doctor's consultation.
Please see your doctor for professional advice.
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