Hidradenitis Suppurativa

What is it?
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Chronic, recurrent inflammatory condition with painful skin nodules. Although the exact cause is not yet understood, contributing factors include:
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friction from clothing and body folds
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unusual immune response to normal body bacteria (commensals)
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occlusion of hair follicles (similar to acne)
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release of pro inflammatory molecules from the immune system
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secondary bacterial infections
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certain medications
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Common areas include the armpits (axilla), groin, under the breasts, and abdominal folds
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Much more common in women then men – about 1% of the population are affected
What are the symptoms?
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It is characterized by persistent or recurrent boil-like nodules and abscesses that culminate in a purulent discharge, sinuses, and scarring.
Do I need to do any tests as part of the diagnosis?
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In most cases the answer is NO as this tends to be a clinical diagnosis
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Hormone levels are typically normal
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It is rare to have to do a skin biopsy for diagnosing this condition
What are the treatment options available?
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No uniformly effective treatment – many different options but often unsatisfactory
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General measures:
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Weight loss, low glycemic diet, low dairy diet
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Smoking cessation
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Loose fit clothing
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Antiperspirants to keep skin folds dry, sometimes Botox can help with this
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Dilute bleach baths if prone to infections
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Antiseptic washes
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Dressings and wound care
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Pain control with acetaminophen or ibuprofen as needed
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1. Antibiotics
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Topical antibiotics with or without benzoyl peroxide
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Oral tetracyclines or dapsone
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Oral Clindamycin/Rifampin combination
2. Hormone based treatments
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Birth control pill
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Spironolactone
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Metformin
3. Intralesional steroid injections
4. Zinc gluconate supplements
5. Immune system suppressing medications
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Methotrexate
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Cyclosporine
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Azathioprine
6. Retinoids - similar to acne treatments
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Accutane
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Acitretin
7. Biologics
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Adalimumab - blocks TNFa inflammation
8. Surgical and laser management
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Incision and drainage of abscesses
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Deroofing of skin lesions (removing the top layer of skin)
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Laser ablation of nodules (CO2)
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Excision of nodules and abscesses
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Surgery of entire area (axillectomy – removing the armpit)