Hidradenitis Suppurativa – The sore skin abscess

HS is a chronic skin condition that affects areas of the body that carry apocrine sweat or sebaceous glands, such as the armpits, inner thighs, groin, buttocks, and breasts.

It is characterized by clusters of abscesses in these areas. Abscesses can start out as little pea-sized nodules (sometimes mistaken for acne). These lesions can spontaneously dissolve or tear and drain a pus-like discharge. Sometimes these abscesses can become very large and require surgical drainage.

These can heal over time, but only to develop new ones in adjacent areas. These chronically developing abscesses lead to fibrosis and scarring as well as the formation of fistulas. Fibrosis and scarring can sometimes be so severe that they cause contractions and reduced mobility. Fistulas refer to abnormal pathways that develop between 2 organs lined with epithelium. For example, with anogenital hidradenitis suppurativa, fistulas can develop that connect the anus to the skin. The presence of these fistulas leads to chronic discharge and non-healing infections.

What are the causes of hidradenitis suppurativa?

The exact cause of hidradenitis suppurativa is controversial. However, the possible causes are:

• Genetic predisposition

• Flashes of sweat or blocked hair follicles

• Androgenic dysfunction

• Profuse sweating

• Bacterial infections

• Possible link with diseases such as Hashimoto’s thyroiditis, Crohn’s disease, squamous cell carcinoma and rheumatoid arthritis.

What are the possible triggers?

There are certain triggers of hidradenitis suppurativa that should be avoided. These include:

• Obesity

• Tight clothes

• Excessive sweating, hot and humid environments

• Use of deodorants, shaving and waxing the affected areas

• to smoke

• Medicines such as oral contraceptives

How is hidradenitis suppurativa treated?

There is no cure for hidradenitis suppurativa, and management is usually aimed at avoiding triggers and treating acute flare-ups.

The type of treatment required depends on the severity and extent of the disease. Mild cases may only require self-care measures such as warm compresses and frequent washing with antibacterial soaps. In moderate cases, topical and oral medications may be needed, which are prescribed by a doctor or dermatologist.

Medications can include:

• Antibiotics – to treat more infections and prevent new outbreaks

• Nonsteroidal anti-inflammatory drugs (NSAIDs) to treat pain and inflammation

• Oral retinoids help stop oil production by the sebaceous glands and prevent clogging of hair follicles

• Tumor necrosis factor (TNF) alpha inhibitors – These drugs have shown promise in the treatment of this condition.

Surgical intervention may be necessary in severe or persistent cases of hidradenitis suppurativa. These can be:

• Incision and drainage of abscesses

• Fistulectomy – This refers to the exposure and opening of the fistula pathways

• Surgical removal of all affected skin, followed by occlusion with skin flaps or skin grafts

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