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Hidradenitis Suppurativa

Causes

The exact cause of hidradenitis suppurativa remains unclear. What is understood is that the condition is a disorder of follicular occlusion. This begins with follicular plugging that obstructs the apocrine gland ducts and perifolliculitis around the ducts. This is followed by rupture of the follicular epithelium, bacterial infection and formation of sinus tracts between abscesses under the skin, all which lead to the characteristic symptoms and signs of hidradenitis suppurativa.

Signs and symptoms

Hidradenitis suppurativa usually develops in otherwise healthy people, but it has been associated with Crohn's disease in some individuals. It is a non-contagious skin disease that usually appears on the body in skin folds of the underarms, groin, or perianal area. It has three main stages, beginning with boils or pockets of infection (abscesses). These become hard, painful, inflamed lumps with drainage (suppuration). Tunnels (sinus tracts) may form around and between the lumps. Scars form. The last stage is the most debilitating, because large areas of skin are affected by the abscesses, sinus tracts, lumps, and scars.

Diagnosis

The diagnosis is made clinically, taking into account the areas that are affected, and the look of the spots. Your doctor may take swabs from the area to see which type of germ is present.

Treatment

Medical management of hidradenitis suppurativa is difficult. The aim is to catch the disease in its early stages and treat and control these milder forms. Weight loss in obese patients and smoking cessation are recommended.

Some general measures include:

• Wash with antiseptics or acne preparations to reduce skin carriage of commensal bacteria. Hydrogen peroxide solution and medical grade honey have been found helpful.
• Wear loose fitting clothing to avoid friction

Surgery is the most effective treatment for hidradenitis. Aggressive surgery will cure an area of severe, chronic hidradenitis but it has to remove scarred tissue or even large areas of skin. Skin grafts may be needed. Incision (lancing) and draining will reliably help smaller affected areas. Because surgery scars and may have complications, medical treatments are usually tried first.