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Hidradenitis Suppurativa

(Acne Conglobata; Acne Inversa [AI]; Apocrine Acne; Apocrinitis; Fox-Den Disease; HS; Hydradenitis Suppurativa; Pyodermia Significa Fistulans; Velpeau's Disease; Verneuil's Disease)

Definition

Hidradenitis suppurativa (HS) is when recurring inflamed nodules (small, solid lumps) and cysts (fluid-filled mass) form in the armpits and groin. These may also be found under the breasts and around the nipples and anus.
Sweat Gland
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Causes

The lesions start as plugged pores in the sweat and oil glands. Material builds up under the skin. The body's inflammatory system attacks these materials. This causes nodules and cysts to form. These lesions can burst under the skin and form an abscess. The area may have a bad smell and may heal and leave a scar.
It is rare to have another infection in these lesions. When it does occur, the bacterium is typically Staphylococcus aureus ("staph"). But, HS is different from true staph infections that cause unrelated conditions (eg, boils , carbuncles). Pilonidal cysts may be seen with HS, but may also occur alone.

Risk Factors

These factors increase your chance of developing HS. Tell your doctor if you have any of these:

Symptoms

If you have any of these symptoms do not assume it is due to HS. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:
  • Painful swellings in the armpits, groin, under the breasts, around the nipples, or around the anus
  • Pus leaking from openings in the swellings
  • Foul smell from the affected areas
  • Scarring
  • Feeling depressed or isolated because of symptoms
See your doctor right away before HS worsens.

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. The exam will include every crease and fold on your body that might be affected. Tell the doctor about every lump, even those that are not visible. A culture of the drainage may be done to identify the bacteria.
You may need to see a dermatologist or a surgeon. If this is the case, find one with experience in treating abscesses and sinuses.

Treatment

Talk with your doctor about the best treatment plan for you. There are various options. Some are more effective than others.

Hot Packs

This treatment is uncertain. Hot packs or warm baths may be used to soften the skin and allow the abscess to drain.

Antibiotics

Long-term use of antibiotics may help stop inflammation. Taking antibiotics this way, though, could lower your resistance to infections.

Cortisone

Cortisone , taken orally for a few days, has shown to be effective in the short-term. Because of side effects, this drug should not be used over the long-term. Cortisone can also be injected or applied to the skin, which may reduce some of the side effects

Male Hormone (Androgen) Suppression

Controlling the male hormone (androgen) may also help. Examples include:
  • Cyproterone acetate—used either alone or combined with ethinyl estradiol , can suppress acne in women and has improved HS (not available in the US)
  • Drospirenone (available as a birth control pill)
  • Flutamide
  • Finasteride
  • Dutasteride
  • Spironolactone

Surgery

Small lesions can be treated in the doctor's office, which could require several visits. If your condition is severe, then a wide area may need to be removed. In these cases, a skin graft may be needed.

Laser Treatment

Laser treatment, including the process used to remove hair, can also be done to remove lesions.

Biologic Medications

Infliximab and etanercept are called "biologic medications." They are used to treat a inflammatory conditions, such as rheumatoid arthritis . These drugs have shown some promise in treating severe HS. Although, they must be injected under the skin and can cause serious side effects.

Prevention

To help reduce your chances of getting HS, take the following steps:

RESOURCES

American Academy of Dermatology http://www.aad.org/

Hidradenitis Suppurativa Foundation http://www.hs-foundation.org/

CANADIAN RESOURCES

Canadian Dermatology Association http://www.dermatology.ca/

Dermatologists.ca http://www.dermatologists.ca/index.html/

References

Beers MH, Berkow R. The Merck Manual . 17th ed. West Point, PA: Merck and Co; 1999.

Bolognia JL, Jorizzo J, Rapini RP. Dermatology . London, England: Elsevier Science; 2003.

Cusack C, Buckley C. Etanercept: effective in the management of hidradenitis suppurativa. Br J Dermatol . 2006;154:726-729.

Fardet L, Dupuy A, Kerob D, et al. Infliximab for severe hidradenitis suppurativa: transient clinical efficacy in seven consecutive patients. J Am Acad Dermatol . 2007;56:624-628.

Hydradenitis supparativa. British Association of Dermatologists website. Available at: http://www.bad.org.uk/public/leaflets/bad%5Fpatient%5Finformation%5Fgateway%5Fleaflets/hidradenitis/index.asp . Accessed July 6, 2008.

Hydradenitis supparativa. DermIS website. Available at: http://www3.dermis.net/dermisroot/en/36184/diagnose.htm .

Hydradenitis supparativa. DermNet NZ website. Available at: http://dermnetnz.org/acne/hidradenitis-suppurativa.html . Updated April 2008. Accessed July 6, 2008.

Hydradenitis supparativa. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated April 2008. Accessed July 6, 2008.

Hydradenitis supparativa. National Organization of Rare Diseases website. Available at: http://www.rarediseases.org/search/rdbdetail%5Fabstract.html?disname=Hidradenitis%20Suppurativa . Published 2002. Accessed July 6, 2008.

Treatment. Hidradenitis Suppurativa Foundation website. Available at: http://www.hs-foundation.org/abouths/treatment.htm . Updated May 2007. Accessed June 6, 2008.

What is hydradenitis supparativa? HS-USA website. Available at: http://hs-usa.org/hidradenitis%5Fsuppurativa.htm . Updated March 2008. Accessed June 6, 2008.

Why avoid milk products. The Acne and Milk website. Available at: http://www.acnemilk.com/the%5Fno%5Fmilk%5Facne%5Fdiet . Accessed July 6, 2008.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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