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Hidradenitis suppurativa

Hidradenitis suppurativa or HS is a poorly studied skin disease that affects areas bearing apocrine sweat glands and hair follicles; such as the underarms, groin and buttocks, and under the breasts in women. more...

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Overview

The disease manifests as clusters of chronic abscesses or boils, sometimes as large as baseballs, that are extremely painful to the touch and may persist for years with occasional to frequent periods of inflammation, culminating in drainage, often leaving open wounds that will not heal. Drainage provides some relief from severe, often debilitating, pressure pain. These flare-ups are often triggered by stress, hormonal changes, or humid heat. Persistent lesions may lead to the formation of sinus tracts, or tunnels connecting the abscesses under the skin. At this stage, complete healing is usually not possible, and progression of the disease in the area is inevitable. Occurrences of bacterial infections and cellulitis (deep tissue inflammation) are likely at these sites. HS pain is difficult to manage.

HS often goes undiagnosed for years because patients are too ashamed to speak with anyone. When they do see a doctor, the disease is frequently misdiagnosed or prescribed treatments are ineffective, temporary and sometimes even harmful. There is no known cure nor any consistently effective treatment.

Although HS is considered a rare disease, its incidence rate is estimated as high as 1 in 300 people.

Other names for HS

  • Acne conglobata
  • Acne Inversa (AI)
  • Apocrine Acne
  • Apocrinitis
  • Fox-den disease
  • Hidradenitis Supportiva
  • Pyodermia sinifica fistulans
  • Velpeau's disease
  • Verneuil's disease

Stages

HS presents itself in three stages:

  1. a few minor sites with rare inflammation; may be mistaken for acne.
  2. frequent inflammations restrict movement and require minor surgery.
  3. inflammation of sites to the size of golf balls, or sometimes baseballs; scarring develops, including subcutaneous tracts of infection (see fistula). Obviously, patients at this stage may be unable to function.

Causes

As this disease is poorly studied, the causes are controvertial and experts disagree. However, potential indicators include:

  • post-pubescent
  • females are more likely than males
  • genetic predisposition
  • plugged apocrine (sweat) gland or hair follicle
  • excessive sweating
  • bacterial infection
  • linked to some immunodeficiency conditions
  • androgen dysfunction
  • genetic disorders that alter cell structure

Research currently implies that people with HS have a tendency towards clogged apocrine glands, which may then become infected with bacteria commonly present on the skin, and the immune system overreacts with excessive inflammation. Attempted treatments can target any of these three aspects of HS.

Read more at Wikipedia.org


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Hidradenitis suppurativa: what you should know
From American Family Physician, 10/15/05

What is hidradenitis suppurativa?

Hidradenitis suppurativa (say: hi-dra-dun-I-tis sup-you-ra-TI-va) is a disease that causes painful bumps or sores in the armpits, groin, and anal area.

Who gets hidradenitis suppurativa?

No one knows what causes hidradenitis suppurativa. More women get it than men. It usually begins after you become a teenager and before age 40. It may run in families, but it is not contagious (no one can "catch" it from you). Poor cleaning does not cause this disease.

How can I tell if I have hidradenitis suppurativa?

If you have hidradenitis suppurativa, you may have itching and burning in the affected areas. You may sweat more there, too. You may notice a painful red bump under your skin that may drain pus. If this does not get better, or you get more of them, you should see your doctor.

How is hidradenitis suppurativa treated?

Treatment depends on how many sores there are, how painful they are, and whether they are infected. Your doctor may wait for one or two weeks to see if the sores get better on their own. Your doctor may give you medicine.

Most people with this disease get the sores again, but it may be years later. For some people, though, the disease gets worse over time. Some people may need surgery. Surgery is the best treatment for hidradenitis suppurativa.

How can I stop flare-ups?

There is no sure way of stopping flare-ups. For some people, shaving or using deodorant irritates their skin. Try not to wear tight clothing around the affected areas and avoid hot, humid climates. A warm bath, antibacterial soap, or antiseptic medicine to stop infection may help.

Staying healthy, exercising, and getting enough sleep may help. If you are overweight, losing weight may help you feel better. Avoiding stress also helps some people.

Where can I get more information?

Your doctor

American Academy of Family Physicians Web site: http://familydoctor.org/545.xml

American Osteopathic College of Dermatology Web site: http://www.aocd.org/skin/ dermatologic_diseases/hidradenitis_suppu.html Telephone: 800-449-2623 Fax: 660-627-2623 e-mail: info@aocd.org

COPYRIGHT 2005 American Academy of Family Physicians
COPYRIGHT 2005 Gale Group

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