Hidradenitis Suppurativa

(Acne Conglobata; Acne Inversa [AI]; Apocrine Acne; Apocrinitis; Fox-Den Disease; HS; Hydradenitis Suppurativa; Pyodermia Significa Fistulans; Velpeau's Disease; Verneuil's Disease)

Definition

Hidradenitis suppurativa (HS) is an inflammatory condition of the hair follicle. Recurrent, inflamed nodules and cysts form in the armpits and groin. These may also be found under the breasts, and around the nipples and anus. Less commonly other areas of the body can be affected.
Sweat Gland
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Causes

The hair follicle becomes blocked causing inflammation of the sweat glands. The blockage may lead to absesses, infection, or scarring.

Risk Factors

HS is more common in women than in men. Other factors that increase your chances of getting HS include:

Symptoms

HS may cause:
  • Burning, itching, or painful lumps in the armpits, groin, under the breasts, around the nipples or anus, or and other involved area
  • Pus leaking from openings in the lumps
  • Excessive sweating
  • Scarring

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. In most cases, the doctor will be able to make a diagnosis by looking at the nodules.

Treatment

Talk with your doctor about the best treatment plan for you. Options may include one or more of the following:

Home Care and Lifestyle Changes

You may be able to improve the condition by taking these steps:
  • Use warm compresses to relieve discomfort and promote abscess drainage
  • Avoid shaving if skin becomes irritated
  • Wear loose-fitting, nonsynthetic clothing
  • Use antibacterial soap
  • Try to avoid heat and humidity
If you smoke, talk to your doctor about finding a program to help you quit . It is also important to maintain a healthy weight and eat a healthful diet. If you need help with losing weight, consider talking to a dietitian who can help you with meal planning.

Medications

Your doctor may prescribe one or more therapies depending on the severity of your HS.AntibioticsYour doctor may recommend oral or topical antibiotics.Corticosteroids and Other ImmunosuppresantsCorticosteroids may help improve symptoms. These can be taken by mouth, applied to the skin, or injected into the area.Other medications called biologics, which decrease the bodies immune response, may be used in severe cases. These medications have many risks, so your doctor will carefully weigh the risks and benefits of using these.Other MedicationsHormonal medications, such as oral contraceptives can used in some cases. At other times, medications called retinoids may be used.

Surgery

Small lesions can be treated in the doctor's office. The sores may be cut open and allowed to drain. If your condition is severe, then a wide area may need to be removed. In these cases, a skin graft may be needed. Other procedure options include:
  • Laser surgery—uses lasers to remove lesions
  • Cryosurgery—uses cold to freeze lesions

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Prevention

There are no current guidelines to prevent HS.

RESOURCES

American Academy of Dermatology
http://www.aad.org

Hidradenitis Suppurativa Foundation
http://www.hs-foundation.org

CANADIAN RESOURCES

Canadian Dermatology Association
http://www.dermatology.ca

Dermatologists.ca
http://www.dermatologists.ca

References

Fardet L, Dupuy A, Kerob D, et al. Infliximab for severe hidradenitis suppurativa: transient clinical efficacy in seven consecutive patients. J Am Acad Dermatol. 2007;56:624-628.

Hidradenitis suppurativa. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 26, 2013. Accessed May 22, 2014.

Hidradenitis suppurativa. National Organization of Rare Diseases website. Available at: http://www.rarediseases.org/rare-disease-information/rare-diseases/byID/358/viewFullReport. Updated September 14, 2012. Accessed May 22, 2014.

Lam J, Krakowski AC, Friedlander SF. Hidradenitis suppurativa (acne inversa): management of a recalcitrant disease. Pediatr Dermatol. 2007;24(5):465-473.

Shah N. Hidradenitis suppurativa: a treatment challenge. Am Fam Physician. 2005;72(8):1547-1552.

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