Hidradenitis suppurativa

Hidradenitis suppurativa is a chronic skin disease that characterized by painful nodules or abscesses under the skin

What is hidradenitis suppurativa?

Hidradenitis suppurativa (HS), also known as acne inversa, is a non-contagious chronic skin disease characterized by inflammatory and painful nodules or abscesses developed in the major skin fold areas, such as armpits, groin, buttocks, and breasts. In some cases, these lesions can lead to tunnels under the skin and scarring.

This disease usually develops during or after puberty, is more common in women, and has a worldwide prevalence of around 1%. It has a big impact on patients’ lives due to pain, which also contributes to poor sleep quality and stigmatization. In consequence, HS patients have a high burden of depression and anxiety. They are also at higher risk of developing inflammatory bowel disease, metabolic diseases, rheumatological disorders, and cardiovascular conditions. HS can also rarely present in association with other diseasesas complex clinical autoinflammatory syndromes.

What causes hidradenitis suppurativa?

The cause of hidradenitis suppurativa is still unknown, but it is considered a multifactorial disease resulting from a combination of genetic, environmental, and immunologic factors including smoking, obesity, and high-fat and high-sugar diet. The primary event in HS development is a defect of the hair follicle which leads to follicular plugging and cyst formation. As a consequence, the cysts may rupture and cause inflammation.

How to detect hidradenitis suppurativa?

Some early signs and symptoms of hidradenitis suppurativa are the appearance of a painful lump that persists for days or weeks and that might drain pus, or blackheads or spots filled with pus in the areas mentioned above. In later stages, puss draining tunnels may form under the skin with wounds that may not heal easily. Currently, there is not a standardized procedure to diagnose HS and the condition is often misdiagnosed initially as an infection or inflammation of the hair follicles, so it is important to go to see a healthcare provider if the symptoms persist, return or appear in different places.

How to prevent hidradenitis suppurativa?

Even though some of the factors that play a role in the development of the disease cannot be controlled, living a healthy lifestyle and getting treatment from the early stage of the condition can help to smooth its symptoms and prevent the disease progression.

How to treat hidradenitis suppurativa?

Hidradenitis suppurativa cannot be cured, but several treatment options are available to control infections, to ease pain, and to manage inflammation and swelling.

The treatment selection is usually based on disease severity and often requires a combination of antibiotic or immunosuppressive therapies and surgical intervention.

  • Topical and oral antibiotics. These are used when there is evidence of an infection during a flare. Topical treatment is usually restricted to mild disease while systemic administration is indicated when more severe or widely spread lesions are present.

  • Pain medication. Non-steroidal anti-inflammatories (NSDAIs) can help with the pain and inflammation.

  • Antihormonal medications. Anti-androgen oral treatments can be useful for women who usually have flares before their periods.

  • Intralesional and systemic corticosteroids. Used for the control of acute flares in mild and moderate to severe stages respectively.

  • Biologics. These drugs are manufactured from living organisms and given by injection. They act on the immune system, blocking molecules involved in the inflammatory process.

  • Surgery. Indicated for patients with severe chronic lesions that do not respond to antibiotic or anti- inflammatory therapy, or in patients with irreversible skin lesions.

References

1. van Straalen KR, Prens EP, Gudjonsson JE. Insights into hidradenitis suppurativa. J Allergy Clin Immunol. 2022 Apr;149(4):1150-1161. doi: 10.1016/j.jaci.2022.02.003. Epub 2022 Feb 19. PMID: 35189127.

2. Zouboulis CC, Benhadou F, Byrd AS, Chandran NS, Giamarellos-Bourboulis EJ, Fabbrocini G, Frew JW, Fujita H, González-López MA, Guillem P, Gulliver WPF, Hamzavi I, Hayran Y, Hórvath B, Hüe S, Hunger RE, Ingram JR, Jemec GBE, Ju Q, Kimball AB, Kirby JS, Konstantinou MP, Lowes MA, MacLeod AS, Martorell A, Marzano AV, Matusiak Ł, Nassif A, Nikiphorou E, Nikolakis G, Nogueira da Costa A, Okun MM, Orenstein LAV, Pascual JC, Paus R, Perin B, Prens EP, Röhn TA, Szegedi A, Szepietowski JC, Tzellos T, Wang B, van der Zee HH. What causes hidradenitis suppurativa?-15 years after. Exp Dermatol. 2020 Dec;29(12):1154-1170. doi: 10.1111/exd.14214. PMID: 33058306.

3. Jalenques I, Ciortianu L, Pereira B, D'Incan M, Lauron S, Rondepierre F. The prevalence and odds of anxiety and depression in children and adults with hidradenitis suppurativa: Systematic review and meta-analysis.J Am Acad Dermatol. 2020 Aug;83(2):542-553. doi: 10.1016/j.jaad.2020.03.041. Epub 2020 Mar 25. PMID: 32222447

4. British Association of Dermatologists. Hidradenitis suppurativa. Available at: https://www.bad.org.uk/pils/hidradenitis-suppurativa/