What is Hidradenitis Suppurativa and How is It Treated?
Hidradenitis Suppurativa is a chronic, disabling, skin disorder affects the apocrine sweat glands and hair follicles in the armpits, groin, genital, and breast regions. It causes painful abscesses and scarring in these areas and is a progressive disease that has no cure.
“It’s a horribly disabling condition,” says Dr. Miriam Hanson, board certified dermatologist in Austin, Texas. “Not only can the condition be uncomfortable, but it is often socially disabling as well.” Dr. Hanson is correct. Many patient report self-consciousness and difficulty with interpersonal relationships that they attribute to their skin disease.
Some of the symptoms of Hidradenitis Suppurativa include:
- Blackheads — these often appear in pairs with a “double-barreled” pattern.
- Abscesses — these lesions often enlarge, break open, and drain pus which can be foul-smelling. They may be accompanied by itching, burning, and sweating.
- Open wounds — these heal very slowly or not at all and lead to scarring and the formation of fistulas.
Causes and Diagnosis
“Why a person is predisposed to hidradenitis is really unknown,” says Dr. Adam Mamelak, board certified dermatologist at Sanova Dermatology. “It has however been associated with other conditions like acne and dissecting cellulitis.” All of these conditions can often result from follicular occlusion – that is, excess keratin accumulation within the hair follicle creates a blockage in the affected areas. The follicle can then becomes inflammed and potentially infected.
Hidradenitis Suppurativa usually begins in adolescence with a single bump or cyst that persists for weeks or months, and it is most commonly seen in the armpits and groin. For some, the disease progressively worsens affecting multiple areas, and for others, it is mild. It is worsened by excessive weight, sweating, stress, and hormonal changes. Diagnosis is usually made through examination of the lesions, and biopsy is rarely needed. A culture may be done to rule out a bacterial infection.
Treatments
There are a variety of treatment options to try to control the disease, but there is always a chance of recurrence.
- Antibiotics — oral or topical antibiotics are used to prevent the disease from worsening and to prevent future outbreaks. An example of these are tetracycline and clindamycin.
- Corticosteroids — oral steroids such as prednisone are used along with injectible forms placed directly into the nodule, and they help control the inflammation.
- Accutane — this treatment for severe and scarring acne has been used with variable success.
- Tumor necrosis factor (TNF)-alpha inhibitors — these include Remicade and Humira and have shown promise in reducing symptoms.
- Surgical interventions — once the disease has progressed, the main option is surgery to remove the abscesses, scarring, and fistulas. Because of the large amount of tissue that usually needs to be removed, a skin graft may be necessary.
- Radiation — this therapy can destroy hair follicles and sweat glands in the affected skin, thereby controlling the disease.
- Laser — both laser hair removal and NG:YAG laser have been shown to aid in the treatment of the disease.
- Botox — similar to its use in hyperhidrosis, Botox has been demonstrated to improve the symptoms of Hidradenitis in a number of reported cases.
There are some basic treatments that can be done at home to help control this disease including weight loss, good hygiene to the affected areas, wearing loose-fitting clothes, and warm compresses with a sodium chloride solution.
While Hidradenitis Suppurativa is relatively rare, affecting only 1-2% of the US population, it is a distressing disease the can cause disability in its sufferers.
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If you suffer from Hidradenitis Suppurativa and are looking for treatment options for you skin condition, please contact us for further information.
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