Causative & risk factors
Hidradenitis suppurativa occurs due to blockage and inflammation of hair follicles. A family history of this condition increases an individual’s risk of developing it.
Certain risk factors include hormonal imbalance, genetic tendencies, obesity and smoking. This condition is not contagious.
Clinical presentation
Hidradenitis suppurativa may affect a single location or multiple. The common locations include the armpits, groins, buttocks, upper thighs or the area beneath the breasts. Usually this condition begins as a single lesion and may progressively involve several body parts.
The presentation can be a combination of blackheads, bumps, lumps and sores. Blackheads usually appear in pairs overlying pitted skin. Erythematous, itchy, painful bumps are seen; frequently associated with excessive sweating. Abscesses may develop which exude a foul-smelling discharge. Chronic, painful lumps may be present under the skin, which go on enlarging.
These lesions may connect with each other forming tunnels under the skin. When the lesions heals, they do so with excessive scarring which may restrict the movement of the affected part.
The symptoms usually exacerbate in response to obesity, excessive sweating, stress and hormonal changes.
Investigations
Diagnosis can usually be made by examining the affected skin. The lesions must be differentiated from acne, boils and folliculitis. If pus or drainage is present, your doctor might send a sample of the fluid to a laboratory for testing.
Treatment
Hidradenitis suppurativa is an incurable condition. The aim of treatment is to relieve symptoms and prevent new lesion formation.
Antibiotics are given in the form of ointments or pills for long term basis. Corticosteroids are given in the form of pills or injections. Other medications such as tumor necrosis factor alpha inhibitors may be prescribed.
Deeper lesions need to be surgically incised and drained. A de-roofing procedure may be done to remove the flesh overlying any tunnels which link separate lesions.
In severe cases, the skin in the affected region needs to be removed completely and replaced with a skin graft.
