Hidradenitis Suppurativa - Causes, Symptoms and Treatment

Definition

Hidradenitis suppurativa is an annoying chronic condition characterized by swollen, painful, inflamed lesions in the axillae, groin, and other parts of the body that contain apocrine glands. The hallmark of the disease is sinus tracts in the apocrine gland body areas. Velpeau first described the condition in 1839. This condition is slightly more common in women and African-Americans. Hidradenitis usually starts as one or more red, tender, swellings in the groin or armpits. Over a period of hours to days the lesions enlarge and often open to the skin surface draining clear to yellow fluid. The involved area then heals with scarring. The condition usually continues for years with periods of flare and remission. The disease is variable and recurrent. Patients may present with solitary or multiple lesions in one area, with lesions in many areas, or in more severe cases may have large, recurrent, draining lesions that never completely heal. Three distinct clinical stages have been defined for the condition.

• Stage 1: Solitary or multiple, isolated abscess formation without scarring or sinus tracts
• Stage 2: Recurrent abscesses, single or multiple widely separated lesions, with sinus tract formation
• Stage 3: Diffuse or broad involvement, with multiple interconnected sinus tracts and abscesses.

Causes

1. Sex: It is more common in women as compared to men.
2. Race: It is more common in Africans and Americans.
3. Age: It is common after you become a teenager or before age 40.
4. Heredity: It may run in families.
5. It is not contagious. Also poor cleaning is not the cause.
6. Shaving, tight fitting clothes, open wounds or recurrent folliculitis are also known to aggravate the skin and cause hidradenitis suppurativa.
7. Local frictional trauma has been proposed to be one of the causative factors.
8. Diabetes, impaired glucose intolerance, and obesity were observed in some patients with hidradenitis. Studies have shown that these entities are only incidental findings and not causative.

Symptoms

1. There may be inflammation from the areas where the lesions present and also pus may present.
2. Hidradenitis suppurativa usually develops in otherwise healthy people, but it has been associated with Crohn's disease in some individuals.
3. These become hard, painful, inflamed lumps with drainage. Tunnels may form around and between the lumps.
4. Anogenital involvement most commonly affects the groin, mons pubis, and vulva, sides of the scrotum, perineum, buttocks and perianal folds.
5. Painful bumps or sores that continually leak fluid. These open wounds heal very slowly, if at all, often leading to scarring and the development of tunnels under the skin.

Treatment

1. Although this disease is not proper curable but there is a lot of treatments which are used to reduce this disease.
2. The nodules of hidradenitis suppurativa may need to be drained in the emergency department, particularly if they are very large, fluctuant, and painful.
3. Antibiotics are indicated if cellulitis or fever is present, and the patient should be admitted if he or she appears to be toxic.
4. Surgery is the most effective treatment for severe, chronic hidradenitis suppurativa. In the worst cases, the entire area of affected skin is removed and replaced with a skin graft.