Hidradenitis suppurativa (hi-drad-uh-NIE-tis sup-yoo-ruh-TIE-vuh) is also known as acne inversa that affects about one percent of the population. It is a chronic skin condition that generally starts after puberty. It may start with just one or two pimple-like lesions that just don’t go away. These bumps may become inflamed, enlarged and hard. Two or three bumps can become several. Hidradenitis can persist for years and worsen over time in a waxing and waning process that may parallel stress, hormonal changes and other factors. Excessive sweating can also exacerbate this condition.
Hidradenitis suppurativa features pea-sized to marble-sized bumps under the skin in areas 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 hidradenitis suppurativa include some obstructions of the sweat glands. 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, as well as age and gender. It most commonly occurs in young adults and women are more affected than men.
While many cases of hidradenitis suppurative 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 fill 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 hidradenitis in the armpit or groin can restrict range of motion.
Limb edema – In advanced cases of hidradenitis, 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 sores emitting foul-smelling pus can led to social isolation, embarrassment and clinical depression.
There is no cure for hidradenitis suppurativa. The mainstay of therapy is early treatment to mitigate progression and sequela.
Medications for hidradenitis suppurativa
Antibiotics – Either oral or topical or a combination of both may be prescribed to prevent progression of the disease or reduce the risk of future outbreaks.
Corticosteroids – Steroids injected directly into the affected areas can reduce inflammation and pain. Oral steroids should be used with caution, given adverse side effects from chronic steroid use such as osteoporosis.
Tumor 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 severe conditions, since they can increase the risk of infection, heart failure and certain types of malignancies.
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 – Also known as “de-roofing,” this approach involves the resection of skin and flesh that cover any skin bridges between tunnels that link separate lesions.
- Surgical removal – In the most advanced cases of hidradenitis suppurativa, the skin and its subcutaneous components may be excised, leaving a large open wound to either heal or covered with a skin graft.
There are certain things one can do at home to help relieve symptoms or even reduce flare-ups and disease progression. First, keep the area clean by showering with an antibacterial soap. Topical antibiotics may also be beneficial. Second, loose fitting clothes in a cotton fabric can reduce sweating and bacterial growth. Third, lose weight if you are overweight. Although easier said than done, weight loss will reduce the friction and irritation between areas. Finally, application of warm compresses can provide some symptomatic relief.
Hidradenitis suppurativa treatment, including surgery, may be covered by health insurance. You may call our office at 310-858-8811 or text 323-975-1287 for a no obligation benefit assessment of your plan. PPO insurance plans are accepted, while HMO plans are not. In the case of no insurance, reasonable payment plans can be arranged.