Hidradenitis Suppurativa

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What is it?

  • Chronic, recurrent inflammatory condition with painful skin nodules.  Although the exact cause is not yet understood, contributing factors include:

    • friction from clothing and body folds​

    • unusual immune response to normal body bacteria (commensals)

    • occlusion of hair follicles (similar to acne)

    • release of pro inflammatory molecules from the immune system

    • secondary bacterial infections

    • certain medications

  • Common areas include the armpits (axilla), groin, under the breasts, and abdominal folds

  • Much more common in women then men – about 1% of the population are affected

What are the symptoms?

  • 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?

  • In most cases the answer is NO as this tends to be a clinical diagnosis

  • Hormone levels are typically normal

  • It is rare to have to do a skin biopsy for diagnosing this condition

 

What are the treatment options available?

  • No uniformly effective treatment – many different options but often unsatisfactory

    • General measures:

    • Weight loss, low glycemic diet, low dairy diet

    • Smoking cessation

    • Loose fit clothing

    • Antiperspirants to keep skin folds dry, sometimes Botox can help with this

    • Dilute bleach baths if prone to infections

    • Antiseptic washes

    • Dressings and wound care 

    • Pain control with acetaminophen or ibuprofen as needed 

 

1. Antibiotics

  • Topical antibiotics with or without benzoyl peroxide

  • Oral tetracyclines or dapsone 

  • Oral Clindamycin/Rifampin combination

 

2. Hormone based treatments

  • Birth control pill

  • Spironolactone 

  • Metformin

3. Intralesional steroid injections

4. Zinc gluconate supplements

 

5. Immune system suppressing medications

  • Methotrexate

  • Cyclosporine

  • Azathioprine

 

6. Retinoids - similar to acne treatments

  • Accutane

  • Acitretin

7. Biologics

  • Adalimumab - blocks TNFa inflammation

8. Surgical and laser management

  • Incision and drainage of abscesses

  • Deroofing of skin lesions (removing the top layer of skin)

  • Laser ablation of nodules (CO2)

  • Excision of nodules and abscesses

  • Surgery of entire area (axillectomy – removing the armpit)

  • Laser Hair removal