Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic inflammatory skin condition that causes painful lumps to form under the skin. These lumps typically develop in areas where the skin rubs together, such as the armpits, groin, buttocks, and under the breasts. The condition can significantly impact a person’s quality of life due to its chronic nature and the potential for severe complications.
Symptoms
The symptoms of HS can vary in severity and may include:
Painful lumps: These usually start as single, painful bumps under the skin that persist for weeks or months.
Blackheads: Often appearing in pairs in small, pitted areas of the skin.
Leaking sores: Some bumps may enlarge, break open, and drain pus with an odor.
Tunnels under the skin: Over time, tunnels (sinus tracts) may form, connecting the lumps and causing slow-healing wounds that drain blood and pus.
Causes
The exact cause of HS is not fully understood, but it is believed to involve a combination of genetic, hormonal, and environmental factors. The condition often begins after puberty, usually before the age of 40. It is more common in women and in Black individuals, possibly due to genetic predisposition.
Risk Factors
Several factors can increase the risk of developing HS
Age: The condition is more common in teens and young adults.
Sex: Women are three times more likely to develop HS than men.
Race: Black individuals have a higher incidence of HS.
Family history: A genetic component is suggested by the occurrence of HS in first-degree relatives.
Obesity: Excess weight can contribute to the development and severity of HS.
Smoking: Tobacco use is linked to worse symptoms and disease progression.
Complications
If left untreated, HS can lead to serious complications
Infection: Secondary bacterial infections can occur.
Scarring and skin changes: Wounds may heal but leave significant scarring.
Restricted movement: Sores and scar tissue can limit mobility, especially in the armpits or thighs.
Skin cancer: Long-term HS can increase the risk of squamous cell carcinoma, particularly in the perianal area.
Lymphedema: Swelling in the arms, legs, or genitals due to lymphatic system damage.
Psychological effects: The condition can cause embarrassment, social isolation, anxiety, and depression.
Diagnosis
HS is diagnosed based on clinical symptoms and the characteristic appearance of the skin lesions. No specific diagnostic tests are required, but a biopsy may be performed to rule out other conditions. The Hurley staging system is often used to classify the severity of the disease
Hurley Stage I: Single or multiple isolated bumps without sinus tracts.
Hurley Stage II: Multiple bumps with sinus tracts and scarring.
Hurley Stage III: Widespread involvement with extensive sinus tracts and scars.
Treatment
Treatment for HS is tailored to the individual and aims to reduce symptoms and prevent disease progression.
Topical and oral antibiotics: To manage infections and reduce inflammation.
Biologics: Medications like adalimumab (Humira) that target the immune system.
Corticosteroids: Injected into the lesions to reduce inflammation.
Hormone therapy: Birth control pills or spironolactone may help some women.
Surgery: Procedures such as de-roofing or wide excision may be necessary for severe cases.
Early diagnosis and a comprehensive treatment plan are crucial for managing HS and improving the patient’s quality of life.
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