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...

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.

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