Hidradenitis Suppurativa

Cause

Due to closure of the exit of hair follicles, the hair follicles become inflamed. The sebacious glands, sweat glands and other skin structures can also get inflamed. The exact cause of the inflammatory process is not known. Several factors may play a role in the emergence and worsening of the disease. Hidradenitis suppurativa has a clear link with smoking of cigarettes. The impression is that many female patients with hidradenitis suppurativa have overweight. There are indications that male sex hormones are important in the development of the inflammations, but it’s unknown how this exactly works. It seems that hereditary factors also contribute to the development of hidradenitis suppurativa. The condition usually begins during or after puberty, often between the ages of twenty and twenty-five years. Hidradenitis suppurativa is not contagious.

Symptoms

Hidradenitis suppurativa is characterized by painful inflammations in the body folds, especially the armpits and groin. The fold under or between the breasts, pubic mound, scrotum, labia, the area around the anus and buttocks may also participate. In the beginning, the inflammation looks like a small boil. Later it’s getting bigger and deeper and can even burst, releasing large amounts of sebum and pus. Healing of the skin can leave scarring. In the longer term, passageways may arise in the skin, which are called sinuses. Also large comedones (blackheads) occur and cysts (cavities in the skin) can be formed. The suppurating discharge from cysts, inflammations and sinuses can cause an unpleasant smell. The inflammations in hidradenitis suppurativa are larger than in ordinary pimples.

Diagnosis

Generally, the doctor can make the diagnosis of hidradenitis suppurativa directly on the basis of the signs and symptoms. Once in a while, a piece of tissue (biopsy) can be taken away under local anesthesia for microscopic examination, in order to exclude other disorders.

Treatment

There are several options to treat hidradenitis suppurativa, but no treatment can solve the problem quickly and permanently. Even when treatment is successful, the disease can often come back. A combination or a sequence of treatments and treatment methods is the best approach in many cases.

• Local treatment. Good hygiene is recommended, for example by using iodine soap in the shower. Additionally, various creams can be used in topical treatment of hidradenitis suppurativa.
• Antibiotics. Most of the patients with hidradenitis suppurativa will be treated with antibiotics in the form of tablets or capsules. Over time, the effect will usually be less. Then may be switched to another antibiotic.
• Surgical treatment. Surgical treatment is an important part of the therapy. In case of very painful inflammations, containing pus (abscess), an incision can be made so the pus comes out. Even after well-executed surgical intervention, the disease may come back again, often outside the operating area. The skin over cysts and sinuses can be ‘burned’ with electrical equipment under local anesthesia. Since the passageways are lined with epidermis, rapid healing with little scarring will usually occur.
• Laser treatment. The laser (CO2 laser) is used in the treatment of hidradenitis suppurativa to remove inflamed tissue, as it were evaporated. As with surgery, this is a major intervention which usually must be performed under local anesthesia and sometimes under general anesthesia. One-time treatment is sometimes sufficient, but often the laser therapy should be repeated.
• Other medications. Women are often treated with ‘antimale sex hormones’ in the form of an oral contraceptive, containing the drug cyproterone acetate. There are also other types of medications which may be effective.

Prognosis

The long-term prospects are, unfortunately, not so good. The symptoms can usually be reduced, but the disease cannot be cured completely.

Considerations

• Given the fact that overweight and smoking have an impact, losing weight and quitting smoking can have a benificial effect.
• Good hygiene is important. Keep the armpit and groin areas daily clean. If necessary, use an antibacterial soap. Wear clean, dry and absorbent underwear.
• Avoid tight clothing and underwear.

Facts

• The French doctor Aristide Auguste Stanislas Verneuil discovered in 1864 that hidradenitis suppurativa arises from an inflammation of the sweat glands.
• The term ‘hidradenitis suppurativa’ is derived from the Greek words hidrōs (sweat), adén (gland) and suppurativa (festering). The suffix -itis indicates that it is an inflammation. ‘Acne inversa’ means ‘acne of the folds’.
• The prevalence of hidradenitis suppurativa is about 1%.
• The condition is most common in women.