Hidradenitis Suppurativa

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Hidradenitis suppurativa (HS) or Acne Inversa is severe form of chronic acne of the sweat glands which produce a scent or odor and are located in the armpit, groin or ano-genital area. Although till recently there was no cure but some advances is helping science find a cure for it.

Hidradenitis suppurativa (HS) is a chronic condition of the sebaceous glands that commonly occurs in those prone to acne. It is a severe form of acne, also known as acne inversa (AI) or Pyodermia fistulans significa or Verneuil's disease or Fox-den disease or Smoker's Boils. Although there may be no cure, the condition can be managed through medications.

It can potentially cause severe chronic inflammatory disorder of oily gland (called apocrine glands - a type of sweat gland that produces a scent or odor) in body areas such as axilla, groin or anogenital region. Its incidence is 1:600 in Caucasians but higher in patients of African descent.


Hidradenitis suppurativa (HS) usually starts around puberty. It continues for several years and tends to worsen with time. It is important to diagnose the condition at an early stage in order to manage the symptoms and to prevent new lesions from occurring.

The condition can be confined to one area or it can occur in different parts of the body and can be very painful. It is characterized by the presence of blackheads and one or many red, tender, pus-filled lesions or abscesses which often enlarge, burst and drain pus. When this repeats, it can result in scarring. Long-term skin inflammation is a common feature.

The causes of HS are not very well known but the condition is found to occur more commonly in women, especially African-Americans, and others who suffered from acne in their teens. The condition can be treated with antibiotics and anti-inflammatory medicines. Sometimes, a surgery is required. Wearing loose clothes and losing weight is known to help too.

Symptoms and Complications

Hidradenitis suppurativa commonly occurs in areas where oil and sweat glands are found in plenty, such as the armpits, groin and anal area. It is also likely to occur in areas of friction, where the skin rubs together, including the inner thighs, below the breasts or in between the buttocks.

Signs and symptoms of hidradenitis suppurativa are the following:

► Blackheads appearing in pairs, presenting a "double-barreled" pattern

► Red, tender bumps or lesions that grow in size break and drain pus giving out an unpleasant odor. Itching, excessive sweating and burning may also occur

► Painful lumps can develop under the skin. They are likely to persist for several years and may get inflamed

► Open wounds can also occur. They heal slowly and lead to scarring

Weight, hormonal changes, stress, heat or excessive perspiration can aggravate the symptoms

Hidradenitis suppurativa complications include:

► Network of sinus tracts or tunnels that prevent healing of the sores and cause more to appear

► Skin changes including scars, pitted skin and dark patches.

► Restricted and painful movement ofarmpits or thighs.

► Cellulitis

Mild cases of HS can be countered with self-care measures but if the condition persists longer, it would be advisable to consult a dermatologist.

Causes and Risk Factors

Hidradenitis suppurativa (HS) develops when the sebaceous glands and the openings of the hair follicles become blocked with a mixture of fluid, dead skin cells, sebum and secretions from the apocrine sweat glands. Bacteria accumulate causing infection and inflammation. HS can occur alone or in combination with Crohn’s disease or Graves Disease.

Many factors such as hormones, genetics and cigarette smoking play a role in predisposing a person to develop HS. The condition occurs equally among all ethnicities.

Hidradenitis suppurativa risk factors include:

► Gender- Women are more prone to develop hidradenitis suppurativa. The reason for this is not known.

Age- Those between puberty and the age of 40 years are more likely to develop HS.

Family history - Having a family history of HS makes one prone to the disease

Diagnosis and Treatment

Diagnosis of hidradenitis suppurativa begins by assessing the medical history and clinical symptoms of the patients. Blood tests and culture of pus samples may have to be carried out. Other skin tests may be ordered to rule out tuberculosis of the skin.

There is no known cure for HS. But early treatment of the condition may help to control the symptoms and prevent new lesions from forming. The intensity of the treatment depends on the seriousness of the disease.

Mild cases of HS may be treated with self care while moderate and severe cases require medications including antibiotics, oral retinoids, non-steroidal anti inflammatory drugs, corticosteroids and tumor necrosis factor alpha inhibitors. Severe cases may be treated with incision, drainage and surgery.

Home remedies

Simple self treatment methods are listed below:

Apply warm compresses to diminish swelling

Clean the affected area with antibacterial soap and apply an over-the-counter antibiotic

Zinc salts may be taken as supplements to minimize inflammation and prevent new outbreaks

Wear loose fitting clothes to prevent skin irritation.

Avoid shaving to prevent irritation of the affected area.

Avoid smoking to allow the disease to improve

Reduce weight as this would help to reduce areas with skin folds and thereby reduce friction

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