Hidradenitis suppurativa
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Overview
Hidradenitis suppurativa or HS is a poorly studied skin disease that affects areas bearing apocrine sweat glands and hair follicles; such as the underarms, groin and buttocks, and under the breasts in women.
The disease manifests as clusters of chronic abscesses, often as large as baseballs, that are extremely painful to the touch and may persist for years with occasional to frequent periods of inflammation, culminating in drainage, often leaving open wounds that will not heal. Drainage provides some relief from severe, often debilitating, pressure pain. These flare-ups are often triggered by stress, hormonal changes, or humid heat. Persistent lesions may lead to the formation of sinus tracts, or tunnels connecting the abscesses under the skin. At this stage, complete healing is usually not possible, and progression of the disease in the area is inevitable. Occurrences of bacterial infections and cellulitis (deep tissue inflammation) are likely at these sites. HS pain is difficult to manage.
HS often goes undiagnosed for years because patients are ashamed to speak with anyone. When they do see a doctor, the disease is frequently misdiagnosed or prescribed treatments are ineffective, temporary and sometimes even harmful. There is no known cure nor any consistently effective treatment.
Although HS is considered a rare disease, its incidence rate is estimated as high as 1 in 300 people.
Other names for HS
Hidradenitis Supportiva
Acne Inversa (AI)
Apocrine Acne
Acne conglobata
Apocrinitis
Verneuil's disease
Velpeau's disease
Fox-den disease
Pyodermia sinifica fistulans
Stages
HS presents itself in three stages:
- a few minor sites with rare inflammation; may be mistaken for acne.
- frequent inflammations restrict movement and require minor surgery.
- inflammation of sites to the size of golf balls, or sometimes baseballs; scarring develops, including subcutaneous tracts of infection. Patients in this stage may be unable to hold down a job.
Causes
As this disease is poorly studied, the causes are controvertial and experts disagree. However, potential indicators include:
- post-pubescent
- females are more likely than males
- genetic predisposition
- plugged sweat gland or hair follicle
- excessive sweating
- bacterial infection
- linked to some immunodeficiency conditions
- androgen dysfunction
Treatments
Treatments may vary depending upon presentation and severity of the disease
- Warm compresses, baths (to induce drainage)
- Intralesional corticosteroid injections (to reduce inflammation)
- Oral antibiotics (to treat inflammation and bacterial infection)
- Wide local excision (with or without skin grafting), or laser surgery
- Radiotherapy
- Anti-androgen therapy
- Changes in diet
External links
- DERMNET NEW ZEALAND (http://dermnetnz.org/acne/hidradenitis-suppurativa.html)
- NIH GENOME RESEARCH (http://www.genome.gov/12513774)
- NHS SPECIALIST LIBRARY FOR SKIN CONDITIONS (http://rms.nelh.nhs.uk/skin/searchResponse.asp?categoryID=8441)
- Dermis.net (http://www.dermis.net/doia/diagnose.asp?zugr=d&lang=e&diagnr=705812&topic=t) (images of the disease -graphic!)
- The Doctor's Doctor (http://www.thedoctorsdoctor.com/diseases/hidradenitis_suppurativa.htm) (extensive medical reference review)
- 2004 HIDRADENITIS SUPPURATIVA Prof J. Revuz (http://www.orpha.net/data/patho/GB/uk-hidradenitis-suppurativa.pdf)
- 2005 SURGICAL TREATMENT HIDRADENITI SUPPURATIVA A.Mandal (http://www.rcsed.ac.uk/journal/svol3_1/3010005.html)
- 2004 HIDRADENITIS SUPPURATIVA M.Jovanovic (http://www.emedicine.com/derm/topic892.htm)
- HS-USA (http://hs-usa.org/home.htm) (non-profit organization)
- eMedicine article (http://www.emedicine.com/emerg/topic259.htm)
- Hidradenitis Suppurativa Links (http://www.frontiernet.net/~ruthb/HidradenitisSuppurativa.html)