About Hidradenitis Suppurativa

Overview

Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic inflammatory skin disease that affects the pilosebaceous unit (hair follicles and oil glands). It is characterized by the presence of painful nodules, abscesses, fistulas, and scars, primarily in areas where the skin folds and rubs together, such as the axillae (armpits), groin, gluteal (buttocks), and submammary (under the breasts) regions. HS typically starts in early adulthood and affects both men and women. The exact cause of HS is not fully understood, but it is believed to involve multiple factors such as genetics, lifestyle, environment, hormones, and microbiota. These factors contribute to immune activation around the hair follicles and thickening of the outer layer of the skin, leading to inflammation and the formation of lesions. HS can have a significant impact on a person's quality of life.

Causes and Risk Factors

Hidradenitis suppurativa is a chronic and painful inflammatory skin condition. The exact cause of HS is not fully understood, but it is believed to involve:

• Follicular occlusion: The primary defect in HS involves the blockage of hair follicles, leading to the formation of abscesses, inflamed nodules, tunnels, and scars.
• Immune response: Pro-inflammatory cytokines and immune cells play a role in the development and progression of HS.

Non-modifiable risk factors of HS include:

• Genetics: There is evidence suggesting a genetic predisposition to HS, as it can run in families.
• Age and gender: HS occurs most commonly in young adults, particularly women.

Modifiable risk factors of HS include:

• Mechanical factors: Pressure or rubbing of skin areas increase the risk of HS.
• Obesity: Excess weight and obesity have been associated with an increased risk of developing HS.
• Smoking: Smoking has been identified as a modifiable risk factor for HS, with studies showing a higher prevalence among smokers.
• Hormonal factors: Hormonal imbalances or changes may contribute to the development or worsening of HS symptoms.

It's important to note that while these factors are associated with an increased risk of developing HS, they do not guarantee its occurrence. If you suspect you may have HS or have concerns about your risk factors, it's best to consult with a healthcare professional for an accurate diagnosis and appropriate management.

Symptoms

Common symptoms of hidradenitis suppurativa include:

• Pea-sized pimples or boils that may disappear, enlarge, or rupture and leak pus after a few hours to days.
• Breakouts that last for a long time.
• Breakouts that clear up but then return.

As the condition reaches higher severity, the following symptoms may occur:

• Chronic deep, painful sores that may rupture and leak fluids like pus or blood.
• Rope-like scarring that forms as the sores heal.
• Scarring that thickens over time.
• Hollow channels deep under the skin (sinus tracts), giving it a spongy appearance.

HS sores can be painful, tender, and cause scarring. In severe cases, extensive scarring and large or leaking infections can significantly affect a person's quality of life. Prompt diagnosis and management can help alleviate symptoms and improve overall well-being.

Diagnosis

To diagnose hidradenitis suppurativa, doctors often rely on a combination of the following examinations, tests, and procedures:

• Health history: The doctor will ask about your medical history and inquire about the location and characteristics of any breakouts you have experienced.
• Physical examination: The doctor will visually inspect the affected areas, looking for specific physical traits that differentiate HS from other similar-looking conditions like boils or acne.
• Swab test: If one of your bumps is leaking fluid, the doctor may take a sample on a swab to test for infection. It's important to note that this test does not directly diagnose HS but helps identify any associated infections.

To determine the severity of HS, doctors may use additional examinations, tests, and procedures such as:

• Hurley staging system: This clinical staging system assesses the severity of HS based on the number of lesions (nodules and abscesses), scarring, and the presence of tunnels beneath the skin. It categorizes HS into three stages: Stage 1, Stage 2, and Stage 3.
• Sartorius Hidradenitis Suppurativa Score: This tool counts and assigns scores to lesions based on tunnels, scarring, and their distance from each other.
• Visual Analog Scale (VAS): A pain measurement tool that helps assess the level of pain experienced by individuals with HS.
• Dermatology Life Quality Index (DLQI): A questionnaire consisting of 10 questions that evaluates the impact of HS on a person's quality of life.
• Hidradenitis Suppurativa Impact Assessment: A questionnaire specifically designed to assess the impact of HS on individuals.
• Hidradenitis Suppurativa Symptom Assessment: Another questionnaire that evaluates the symptoms associated with HS.
• Acne Inversa Severity Index (AISI): A measurement tool used to assess the severity of HS symptoms.

These examinations, tests, and procedures help doctors diagnose and determine the stage or severity of hidradenitis suppurativa. Remember to consult with your healthcare professional for personalized advice as they can provide specific recommendations based on your individual situation.

Treatment Options

The goals of treatment for hidradenitis suppurativa are to reduce skin lesions, manage symptoms, prevent disease progression, and improve quality of life. Recommended treatments include:

Medications:

• Antibiotics: Used to control bacterial infection and reduce inflammation.
• Corticosteroids: Help reduce inflammation and pain.
• Immunosuppressants: Suppress the immune system to decrease inflammation.
• Retinoids: Regulate cell growth and reduce inflammation.
• Hormone therapy: Can help regulate hormones that may contribute to HS.
• Biologics: TNF inhibitors are approved for moderate to severe HS and work by targeting specific proteins involved in the immune response.
• Pain management: Medications can be used to manage pain associated with HS.

Therapies and Therapeutic procedures:

• De-roofing: Removing the tops of lesions to promote healing.
• Wide excision: Surgical removal of affected areas in advanced cases.
• Laser hair removal: Reduces hair growth and decreases blockage of hair follicles.
• Psychological counseling: Helpful for coping with the emotional effects of the disease.

Self-care and health behavior changes:

• Maintaining good hygiene
• Weight loss if overweight
• Smoking cessation
• Wearing loose-fitting clothing.

It's important to note that treatment is individualized based on the severity and extent of lesions, and complications. Consult with a dermatologist or healthcare professional for personalized treatment recommendations. Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Side effects can occur. Check with your health care professional or read the information provided with your medication for side effect information.