Hidradenitis suppurativa

Hidradenitis suppurativa or HS is a skin disease that affects areas bearing apocrine sweat glands and hair follicles; such as the underarms, groin and buttocks. It is more commonly found in women and can be present under the breasts.

Causes

As this disease is poorly studied, the causes are controversial and experts disagree. However, potential indicators include:

- post-pubescent individuals are more likely to exhibit HS

- females are more likely than males

- genetic predisposition among families

- plugged apocrine (sweat) gland or hair follicle

- excessive sweating

- bacterial infection

- sometimes linked with other auto-immune conditions

- androgen dysfunction

- genetic disorders that alter cell structure

- stress can bring on outbreaks

- being overweight makes it worse, however this condition is not caused by obesity and weight loss will improve but not cure it. Patients with more advanced cases may find exercise intolerably painful, which may increase the rate of obesity among sufferers.

The historical understanding of the disease is that there is a dysfunctional apocrine glands or dysfunctional hair follicles, possibly triggered by a blocked gland, creating inflammation, pain, and a swollen lesion. More recent studies imply there is an autoimmune component.

HS is not caused by any bacterial infection -- any infection is secondary -- and is therefore not contagious. Most cultures done on HS lesions come back negative for bacteria, so antibiotics should be used only when a bacterial infection has been confirmed by a physician.

Severe complications

Left undiscovered, undiagnosed, or untreated, the fistulas from severe stage-3 HS can lead to the development of squamous cell carcinoma in the anus or other affected areas.

Treatments

Treatments may vary depending upon presentation and severity of the disease. Due to the poorly-studied nature of this disease, the effectiveness of the drugs and therapies listed below is not yet clear, and patients should discuss all options with their doctor or dermatologist. Nearly a quarter of patients state that nothing relieves their symptoms. A list of treatments that are possible treatments for some patients is as follows.

Lifestyle

- Changes in diet avoiding inflammatory foods, foods high in refined carbohydrates.

- Warm compresses, hydrotherapy, balneotherapy

Medication

- Hexachlorophene shower with liquid soap like Phisohex, covering sores with Metrolotion after medicated showers.

- Corticosteroid injections.

- Antibiotics orally (only in presence of bacterial infection)

- Vitamin A supplementation

- Isotretinoin (Accutane), a prescription-only oral acne treatment (benefits for HS are very controversial, but it is generally considered to be ineffective)

- Anti-androgen therapy

- IV or subcutaneous infusion of anti-inflammatory (anti-TNF-alpha) drugs such as infliximab (Remicade), etanercept (Enbrel), and adalimumab. This use of the drugs is not currently Food and Drug Administration (FDA) approved and is somewhat controversial, and therefore may not be covered by insurance.

- Acitretin

- Zinc gluconate taken orally has been shown to induce remission

Surgery

- Incision and drainage or lancing

- Wide local excision (with or without skin grafting)

- Laser surgery

- Radiotherapy