Hidradenitis suppurativa (skin and abscesses)

Skin | Dermatology | Hidradenitis suppurativa (skin and abscesses) (Disease)


Description

Hidradenitis suppurativa is an inflammatory skin disease that is characterised by recurrent boil-like lumps (abscesses) that culminate in pus-like discharge, difficult-to-heal open wounds and scarring.

Women are affected by hidradenitis suppurativa three times as often as men, the reason for this is unknown. The condition most commonly occurs between 20-40 years and coincides with the post-pubertal increase in androgen levels. Disease onset rarely occurs before puberty and after menopause.

In some people, hidradenitis suppurativa makes up one part of follicular occlusion syndrome when it is associated with acne conglobata, dissecting cellulitis and pilonidal sinus.

Causes and Risk factors

The following are thought to play a role in the development of hidradenitis suppurativa: genetics – frequently reported cases of hidradenitis suppurativa affecting multiple members of a family;

sex hormones – apocrine sweat glands are stimulated by androgen and suppressed by oestrogen (exact role these hormones play remains controversial); endocrine factors – obesity, hirsutism and acne are common findings among women with hidradenitis suppurativa; cigarette smoking – hidradenitis suppurativa occurs more frequently in smokers than non-smokers

Hidradenitis suppurativa commonly occurs on apocrine sweat gland-bearing skin such as in the groin, the underarms and under the breasts. It is also known as ‘acne inversa’.

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.

Diagnosis and Treatment

Regarding the treatment for hidradenitis suppurativa very mild cases can be treated with warm compresses. Most cases require oral antibiotics. If a surrounding skin infection has occurred (cellulitis) intravenous antibiotics may be needed. If an abscess has developed the area may need to be opened and drained. If the same area becomes involved multiple times a surgeon may need to remove the damaged skin and sweat glands. ...