HIDRADENITIS SUPPURATIVA

(Acne Inversa)

 Basic information

description

Hydradenitis suppurative is a chronic, recurrent, inflammatory skin disease. Hydradenitis means inflammation of the sweat glands. Suppurative means pus-forming. The armpits are usually affected, but it can occur on the buttocks, groin, or under the breasts in females. The skin symptoms vary widely in different persons. It develops after puberty, usually in people ages 20 to 40, and affects females more than males.

FREQUENT SIGNS & SYMPTOMS

• It can begin with a cluster of 2 or 3 blackheads.
• Red, tender bumps (called lesions) develop.
• The lesions fill with pus which leads to abscesses (or boils). Draining pus causes a foul odor.
• Abscesses can grow to be as large as an orange or can be as small as a green pea. They are generally hot, tender, and painful to the touch.
• The abscesses heal incompletely and cause cord-like scars on the skin.
• The infection can progress under the skin in tracts linking the abscesses. These can be very painful and restrict movement of the affected area.

causes

The exact cause is unclear. It looks similar to acne and may be caused by the formation of keratin plugs in the hair follicles. It occurs in areas that contain apocrine (sweat) glands, so it may be caused by a blockage of the apocrine gland. In either case, the plugged gland or follicle becomes larger, ruptures, and becomes infected. The disorder is not contagious.

risk increases with

• Family history of the disease.
• Females more than males (hormones may play a role).
• Obesity, acne vulgaris, cigarette smoking, or disorders such as inflammatory bowel disease may play a role.
• Flare-ups may be caused by stress, sweating, clothing friction, and heat and humidity. It is not a hygiene issue.

PREVENTIVE MEASURES

No specific preventive measures.

expected outcomes

There is no cure, but treatment can relieve symptoms and prevent progression. Different treatments may need to be tried. Recurrence is common.

possible complications

• Distress and embarrassment about the symptoms.
• Depression.
• Extensive lesions that do not respond to treatment.
• Scarring (may restrict mobility in affected area).
• Medical problems such as skin cancer or others due to infection, inflammation, or lack of treatment.

 diagnosis & treatment

general measures

• Your health care provider can usually diagnose the disorder by an exam of the affected area. Medical tests may be done to check for infection or other problems.
• Treatment depends on the severity (called stages) of the disease. It usually involves self-care measures, drug therapy, surgery, or other procedures. No specific therapy works for all patients.
• Surgery to drain or remove affected area may be recommended. Other medical procedures may be options.
• For self-care:
  • Avoid tight clothing or clothes that irritate the skin.
  • Wash with antibacterial soap. Don't shave the area.
  • Avoid stress if you can. It may worsen symptoms.
  • Stop smoking. Find a way to quit that works for you.
  • Use cool-water soaks for itching or warm-water soaks for pain and inflammation.
• To learn more: Hydradenitis Suppurative Foundation, 7895 Via Belfiore #4, San Diego, CA 92129; website: www.hs-foundation.org.

medications

• You may be prescribed:
  • Oral or topical antibiotics to fight infection.
  • Hormones or retinoids to help with healing.
  • Anti-inflammatory drugs for pain and swelling.
  • Oral or injected corticosteroids for inflammation.
  • Other drugs depending on the extent of the disease.
• Use nonprescription pain relievers for pain.

activity

Restrict your activity in hot weather. Avoid getting overheated and sweating. Swimming is a good activity.

diet

No special diet, unless you need to lose weight. Losing weight may help ease the symptoms.

 notify our office if

• You or a family member has symptoms of hidradenitis suppurativa.
• Treatment is not working. Different methods of treatment are available and not all work for each individual.

Special Notes: