Hidradenitis Suppurativa

  • Medical Author:
    Gary W. Cole, MD, FAAD

    Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Hidradenitis suppurativa facts

  • Hidradenitis suppurativa is a chronic inflammatory disease that most often affects the skin of the armpits and groin.
  • Hidradenitis suppurativa produces deep, red, and tender abscess-like lesions that begin in the hair follicles in the skin.
  • There is a heritable tendency to develop hidradenitis suppurativa.
  • Bacteria play a supporting role in the development of hidradenitis suppurativa.
  • The severity of hidradenitis suppurativa varies from mild to debilitating.
  • Hidradenitis suppurativa is associated with obesity, hyperlipidemia, diabetes, arthritis, inflammatory bowel disease, polycystic ovarian syndrome, and depression.
  • Treatment approaches vary from topical to systemic to surgical depending on severity.

What is hidradenitis suppurativa?

Hidradenitis suppurativa is a chronic inflammatory condition that affects hair follicles in the armpits and groin but occasionally may involve the buttocks and scalp. The lesions often first appear in puberty but may begin at any age. The lesions appear as tender, red abscesses that may drain. Severe hidradenitis suppurativa can involve larger areas of skin, producing multiple draining sinuses with scarring.

What causes and risk factors of hidradenitis suppurativa (HS)?

Although as many as 40% of patients with HS have a family history of this condition, the precise genetic defect is poorly understood. Health researchers have found a defect in the gamma-secretase Notch signaling pathway in a few patients, but this basic cell regulatory pathway appears mutated only in a minority of those with HS. Patients with HS tend to be obese and frequently smoke. There is microscopic evidence that inflammation in the hair follicles is the seat of the problem and not the apocrine sweat glands as was originally believed. Ultimately, the precise cause is unknown.

Obesity, high cholesterol (hyperlipidemia), diabetes, arthritis, inflammatory bowel disease, polycystic ovarian syndrome, and depression are risk factors for hidradenitis suppurativa.

Hidradenitis Suppurativa Sign

Drainage of Pus

Drainage of pus is a typical consequence of a bacterial infection. Bacterial infection can either be localized, such as an infection of a small cut or wound in the skin, or it may spread to involve larger areas of the body. A number of different infections can cause small bumps or nodules that may drain pus.

What are hidradenitis suppurativa symptoms and signs?

Patients with HS develop recurrent boil-like lesions in their armpits and groin. Individual lesions may join to produce long draining sinus tracts that are tender and continually produce foul-smelling pus drainage. When healing occurs, it often leaves multiple unsightly scars. Less commonly, lesions can involve the lower abdomen and the tissues under the breasts.

What types of physicians treat hidradenitis suppurativa?

Dermatologist are well equipped to care for patients with this condition although they may require surgical support if removal of significant portions of the armpits and groin are required for control.

How do health care professionals diagnose hidradenitis suppurativa?

A patient with recurrent abscesses in the armpit, groin, or buttocks may well have HS. The condition may vary from mild to quite severe. Infections produced by bacteria or fungi need to be excluded because they often are quite curable with antibiotics, whereas HS is not. Doctors may check patients for immune deficiency diseases.

What are treatments and home remedies for hidradenitis suppurativa?

Since this is a chronic recurrent condition, there are many treatment options depending on the severity. For mild disease with infrequent lesions, doctors recommend that patients use topical antibiotics, lose weight, stop smoking, and avoid tight underwear. For more severe involvement, it may be necessary to add an oral antibiotic, such as doxycycline. Since this is a chronic and difficult condition, doctors have proposed various other options, but most lack compelling evidence of efficacy. Physicians recommend finasteride (Proscar), a drug used to treat benign prostatic hypertrophy, as an option to treat HS in certain patients with resistant disease. In view of its cost and safety profile, it seem a reasonable alternative in patients who are unresponsive to conventional measures. There is anecdotal evidence that an oral retinoid, acitretin, can be of benefit.

The FDA recently approved a new injectable medication, adalimumab (Humira), for moderate to severe HS. Humira is one of a class of medications called tumor necrosis factor inhibitors, which intercept a chemical messenger of inflammation.

Occasionally, it may be necessary to resort to surgery to control and treat HS. It may be necessary for physicians to surgically open persistent chronic fistulous tracts to facilitate healing. Rarely, extensive removal of significant portions of axillary (armpit) or inguinal tissue may be required, followed by skin grafting.

What is the prognosis of hidradenitis suppurativa?

Since HS is a chronic, recurrent condition, a cure is unlikely, but with the advent of new drugs that are effective modulators of inflammation, it is reasonable to expect safe and effective control of this difficult condition.

Is it possible to prevent hidradenitis suppurativa?

Currently, there is no known method of prevention of HS.

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Medically Reviewed on 8/14/2018
References
REFERENCES:

Lindhardt Saunte, Ditte Marie, and Gregor Borut Ernst Jemec. "Hidradenitis Suppurativa: Advances in Diagnosis and Treatment." JAMA 318.20 (2017): 2019-2032.

Vekic, Dunja Ana, John Frew, and Geoffrey David Cains. "Hidradenitis Suppurativa, a Review of Pathogenesis, Associations and Management. Part 1." Australasian Journal of Dermatology (2018): 1-11.

Vekic, Dunja Ana, and Geoffrey David Cains. "Hidradenitis Suppurativa, a Review of Pathogenesis, Associations and Management. Part 2." Australasian Journal of Dermatology (2018): 1-6.
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