Description

Hidradenitis suppurativa (hi-drad-uh-NIE-tis sup-yoo-ruh-TIE-vuh), also known as acne inversa, is a condition that causes small painful lumps to form under the skin. The nodules usually develop in areas where the skin rubs together, such as the armpits, groin, buttocks, and breasts. The bumps heal slowly, repeats, and that can lead to the tunnels beneath the skin and scars.

Hidradenitis suppurativa tends to start after puberty, usually before 40 years of age. It can persist for many years and worsen with time. It can affect your daily life and emotional well-being. Combined medical and surgical treatment can help control the disease and prevent complications.

Women are three times more likely to develop hidradenitis suppurativa, although this proportion may vary according to the location of the whole world. Also, Black people are more likely to develop this disease than people of other races. This can be attributed to genetic factors.

Symptoms

Hidradenitis suppurativa can affect one or more areas of the body. The signs and symptoms of the disease include:

  • The black dots. The black points appear in small pitted areas of the skin, often appearing in pairs.
  • Painful, pea-sized lumps. The condition usually begins with a single painful lump under the skin that persists for weeks or months. More shots can be formed later, usually in areas where there is more sweat and oil glands, or where the skin rubs together, such as the armpits, groin, buttocks, and breasts.
  • Brain lumps or sores. Some lumps or sores in the large, open and drain the pus with an odor.
  • The tunnels. Over time, the tunnels can form under the skin, the connection of the packages. These wounds heal slowly, if at all, and to drain the blood and pus.

Some people with this condition experience only mild symptoms. The course of the disease is very variable. The excess of weight and being a smoker were associated with worse symptoms, but people who are thin and not smoking, you may experience severe disease.

When to see a doctor

The early diagnosis of hidradenitis suppurativa is the key to an effective treatment. Consult your dermatologist if your condition:

  • It is painful.
  • Makes it difficult to move.
  • Does not improve in a couple of weeks.
  • Returned within a few weeks of treatment.
  • It appears in several places.
  • Flares often.

Your dermatologist can create a treatment plan for you.

Hidradenitis suppurativa is not only a boil, and many people with this condition have also been linked conditions. People with hidradenitis suppurativa benefit from a team of health care with medical and surgical dermatologists in the nucleus. Other specialists involved as necessary.

Causes

Hidradenitis suppurativa occurs when hair follicles are blocked, but why this blockage occurs, it is not known. Experts believe it could be connected to the hormones, genetic predisposition, smoking and excess weight.

An infection or are soiled will not cause hidradenitis suppurativa, and cannot be spread to other people.

Risk factors

The factors that increase the likelihood of developing hidradenitis suppurativa include:

  • Age. The risk of hidradenitis suppurativa is higher in people in the late teens and early 20s.
  • Sex. Women are more likely to develop hidradenitis suppurativa than the males.
  • Of the race. Ethnicity or race could affect the level of risk. The condition occurs more in people of Black race, possibly due to genetic factors.
  • The history of the family. A tendency to develop hidradenitis suppurativa can be inherited.
  • Certain conditions. Hidradenitis suppurativa is more common and severe in people with overweight. Also has an association with severe acne, arthritis, diabetes, metabolic syndrome, and inflammatory bowel disease.
  • The habit of smoking. Smoking tobacco has been linked to the hidradenitis suppurativa.

Complications

Persistent and severe hidradenitis suppurativa can cause complications, such as:

  • Infection. The secondary infection is possible in the affected area, but the presence of pus, it is common in hidradenitis suppurativa and do not necessarily mean the infection.
  • Scars and skin changes. The wounds may heal but leave ropelike scarring or marking of the skin.
  • Limited movement. Sores and scars can cause limited or painful movement, especially when the disease affects the armpits or thighs.
  • The skin cancer. Squamous cell carcinoma has been reported as long-term hidradenitis suppurativa, particularly in people whose condition implies the perianal area. This area consists of the tissues around the anus.
  • Swelling in the arms, legs or genitals. The most common sites for hidradenitis suppurativa also contain many of the lymph nodes. The scar tissue can interfere with the drainage of the lymph system, which can cause the arms, legs, or genitals to swell.
  • Psychological effects and social isolation. The location, drainage, and the smell of the sores can cause embarrassment and reluctance to go out in public, which leads to anxiety or depression.
  • A lifetime of pain. This pain is much worse than diseases such as psoriasis.

Diagnosis

Hidradenitis suppurativa can be confused with pimples or acne. For many people, it takes years to receive a correct diagnosis.

Your health care provider on the basis of a diagnosis about your signs and symptoms, the appearance of the skin, and medical history. You may be referred to a doctor who specializes in diseases of the skin, also known as a dermatologist. Hidradenitis suppurativa can be difficult to diagnose and requires specialized care.

No laboratory test is available to diagnose hidradenitis suppurativa. But if the pus or discharge is present, your doctor may take a sample for laboratory testing.

Treatment

The treatment with drugs, surgery, or both, can help control symptoms and prevent complications of hidradenitis suppurativa. Talk with your health care provider about the risks and benefits of treatment options, and how to develop an appropriate approach for you.

Expect to have regular follow-up visits with your dermatologist. Some people might need the comprehensive care provided by a health care team with members of various medical specialties.

Drugs

Your health care provider may prescribe one or more of these types of drugs:

  • Antibiotics. An antibiotic is applied to the skin, in liquid or gel form can be used to manage mild symptoms. These types of medications called topical antibiotics. For more widespread of the disease, your health care provider may prescribe antibiotic pills, such as doxycycline, or Monodox; clindamycin, or Cleocin; rifampin, or Rimactane; or in more than one of these medications. Rifampicin is also known as rifampicin. People with severe disease may need to take antibiotics for months.
  • The steroid injections. Triamcinolone acetonide, or Kenalog-10 is injected into the sores may reduce swelling and inflammation.
  • The Hormone therapy. Pills hormones, such as estrogen-containing combined oral contraceptives such as estradiol and estradiol/norgestimate may be effective for people with mild hidradenitis suppurativa. Spironolactone is often used to reduce the need for antibiotics, and isotretinoin, which is a medication that is primarily used to treat acne. Isotretinoin is sometimes used for the treatment of hidradenitis suppurativa.
  • Biological products. These drugs, usually administered by injection, alter the immune system in a way that disrupts the cycle of the disease and improves the symptoms and signs of the disease in a matter of weeks. Several of these medications are approved for the treatment of moderate-to-severe hidradenitis suppurativa. Two are inhibitors of tumor necrosis factor adalimumab or Humira, and infliximab or Remicade. These medicines work by dampening the part of the immune system called tumor necrosis factor. Many other biological products are in clinical trials for hidradenitis suppurativa.
  • The retinoids. Oral retinoids may be an option for some people with acne as a disease. These medications are not recommended during pregnancy, lactation or if you plan to become pregnant.
  • Medication for pain. If the pain medicine available without a prescription does not help, your health care provider may prescribe a stronger pain medication or refer you to a pain clinic.

Surgery or other procedures

Combined medical and surgical approaches to help manage hidradenitis suppurativa. The surgery is an important part of the management of the disease when a tunnel, and blow, or an abscess, are present. The surgical approach is the right one for you depends on the extent and the severity of your condition. Talk with your health care provider about the risks and benefits of the options, including:

  • The discovery of the tunnels. This procedure involves the removal of tissue to expose the tunnels under the skin. This is also known as decortication. It's used for people with moderate to severe hidradenitis suppurativa. This solution, in general, does not have to be repeated.
  • Punch debridement. This procedure, also called limited decortication, involves the removal of a single lump inflamed.
  • The laser therapy. A carbon dioxide laser can be used to make the hidradenitis suppurativa sores disappear. After this treatment, the ulcers are unlikely to return. Laser hair removal can help hidradenitis suppurativa in its early stages.
  • The surgical removal. This approach could be an option for people with persistent or severe symptoms. This involves the removal of all the affected skin. A skin graft may be needed to close the wound. Even after surgery, wounds, could still occur in other areas.
  • Incision and drainage. Surgical drainage is no longer considered an effective option for the treatment of hidradenitis suppurativa. The method can be considered to provide short-term to relieve the pain, but the wounds of the flare again later.

Lifestyle and home remedies

Mild hidradenitis suppurativa can sometimes be effectively controlled with self-care measures. Self-care is also an important complement to medical treatment.

These suggestions can help to alleviate discomfort, speed healing or prevent flare-ups:

  • Follow a daily skin care routine. Gently wash your body with a cleaning product that is not soap. It can sometimes be useful to use a washing antiseptic such as chlorhexidine 4% or benzoyl peroxide wash in the shower. Try it once a week at first and then increase the usage to once a day if your skin tolerates it well. Pat dry. When washing, avoid the use of cloths, loofahs or other items in the affected areas, as they may irritate the skin. Do not squeeze the pimples and sores. And avoid shaving or using hair removal or depilatory creams.
  • Manage your pain. Gently the application of a warm compress can reduce swelling and relieve the pain. Ask your health care provider about an appropriate pain reliever and how to take care of his wounds at home.
  • Try to maintain or achieve a healthy weight and stay active. Do not be in a healthy weight can worsen the symptoms of hidradenitis suppurativa. Talk with your health care team to develop a plan. Try to find activities that do not irritate the skin.
  • Consider altering your diet. Diets that include dairy products, red meat and foods with a high glycemic index may worsen the hidradenitis suppurativa symptoms. If your diet includes these foods, talk with a dietitian about the benefits of removing them.
  • Stop smoking. If you smoke, try to quit. Quitting smoking can relieve the symptoms of hidradenitis suppurativa.

Coping and support

Hidradenitis suppurativa can be a challenge for your emotional health and well-being. Painful sores may affect your sleep, the ability to move or sex life. Or the sores could drain the pus with an odor, which might make you feel anxious, shame, anger, self-conscious or depressed. The ongoing, persistent nature of the disease and its treatment challenges that add to the burden.

Try to find the support of your family and friends. The concern and understanding of other people with hidradenitis suppurativa can also be comforting. Ask for help with their mental health and coping strategies. Your doctor may refer you to a mental health professional, or provide the contact information for a support group.

Preparing for your appointment

It is likely that you first consult your primary care provider. It could then be referred to a doctor who specializes in the diagnosis and treatment of diseases of the skin, also known as a dermatologist. Depending on the severity of your condition, your care may also involve specialists in colorectal surgery, plastic surgery or gastroenterology.

Here's some information to help you prepare for your appointment.

What you can do

Make a list of:

  • The symptoms you are experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • All the drugs, vitamins, and supplements you are taking, including dosage.

Also, keep in mind the questions to ask your health care provider, including:

  • What is the most likely cause of my symptoms?
  • There are other possible causes?
  • Do I need any tests?
  • How long will my condition in the past?
  • What treatments are available, and which do you recommend for me?
  • What side effects can I expect from treatment?
  • It is this condition related to another medical condition?
  • Do you have any brochures or other printed material that I can take with me? What sites do you recommend?

What to expect from your doctor

Your health care provider is likely to ask several questions, such as:

  • When did your symptoms begin?
  • What made the bumps in the skin to look like when you started?
  • They do not come in the same places?
  • Your symptoms are painful?
  • Your parents or siblings ever had this problem?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Do you smoke or use tobacco products?
Symptoms and treatment of Hidradenitis suppurativa