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Hidradenitis

Hidradenitis suppurativa

Hidradenitis suppurativa (hi-drad-uh-NIE-tis sup-yoo-ruh-TIE-vuh) is also known as acne inversa that affects about 1% of the population.   It is a chronic skin condition that generally starts after puberty. It may start with just a single or two pimple like lesions that just doesn’t go away.  These bumps may become inflamed, enlarge, and harden.  Two, or three bumps can then become several. Hidradenitis  can persist for years and worsen over time in a waxing and waning process that may parallel stress, hormonal changes. Excess sweating can also exacerbate the condition.

Hidradenitis suppurativa features pea-sized to marble-sized bumps under the skin where skin rubs together such as the armpits, groin, between the buttocks and under the breasts. The lesions associated with hidradenitis suppurativa are often painful.  In advanced cases the pimple like pustules break open and drain foul-smelling pus. Sometimes,  tunnels form under the skin connecting the lumps.

The condition ranges from very mild symptoms to one that can be tremendously embarrassing, painful, and deforming as scar tissue forms from the pustules.

Causes of hydradenitis suppurativa include some form of sweat gland obstruction.  While the exact cause of this blockage is not clear, there appears to be a genetic component.  Obesity and smoking may also be contributing factors. Other contributing factors are age and sex.  It most commonly occurs in young adults where women are more affected than men.

Problems associated with hidradenitis suppurative

While many cases are mild and require no medical attention, more extreme cases can be quite debilitating.

Scars and skin color changes. When lesions become inflamed or infected, they will fil up with pus and break into an open wound.  Because the sores are deeper than just the skin, they will leave permanent scars.

Restricted movement. Swelling or scar formation from hydradenitis in the armpit or groin can restrict range of motion.

Limb edema. In advanced cases of hydradenitis, swelling can obstruct the lymph nodes in the armpit and groin resulting in limb edema.

Depression.  Severe cases will include armpits, groin, and perhaps even the breast, face or neck.  Large open, foul smelling pus draining sores can led to social isolation, embarrassment, and clinical depression.

Treatment for hydradenitis suppurativa

There is no cure for hidradenitis suppurativa. The mainstay of therapy is early treatment to mitigate progression and sequela.

Medications for hydradenitis suppurativa

Antibiotics. Either oral or topical or combination of both may be prescribed to either prevent progression of the disease or reduce risk of future outbreaks.

Corticosteroids. Sometimes, steroid injections directly into affected areas can reduce inflammation and pain. Oral steroids may be used but with caution given adverse side effects from chronic steroid use such as osteoporosis.

TheTumor necrosis factor (TNF)-alpha inhibitors. Medications such as infliximab (Remicade) and adalimumab (Humira) show promise in the treatment of hidradenitis suppurativa. However, these drugs must be used with extreme caution and only in very sever conditions since they can increase the risk of infection, heart failure and certain types of malignancies.

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Surgical and other procedures

Hydradenitis suppurativa

Hydradenitis suppurativa

Surgery may be necessary in advanced cases that don’t respond well to medications.

  • Incision and drainage. This approach has its limitations. The procedure describes making an incision into affected pustules to release pus.  The lesions are then left open to drain.
  • Debridement or “de-roofing” describes resection of skin and flesh that cover any skin bridges between tunnels that link separate lesions.
  • Surgical removal. In the most advanced cases of hydradenitis suppurativa, the skin and its subcutaneous components may be excise leaving a large open wound to either heal in by itself or be skin grafted.

Management at home

There are certain things one can do at home to help relieve symptoms or even reduce flare ups or disease progression.  For one, keep the area clean.  Shower with an antibacterial soap.  Topical antibiotics may also be of help. Two, loose fitting clothes of cotton fabric can reduce sweating and bacterial growth.  Lose weight if you are overweight.  Although easier said than done, weight loss will reduce the friction and irritation between areas. Lastly, warm compresses can provide some symptomatic relief to indurated regions.

Is Hydradenitis suppurativa treatment covered by insurance?

Hydradenitis suppurativa treatment including surgery may be covered by health insurance.  You may call the office (310) 858-8811 for a free, no obligation benefit assessment of your plan.  PPO insurance plans are accepted.  HMO plans are not. In the case of no insurance, reasonable payment plans can be arranged.