What is Hidradenitis Suppurativa?
Once thought to be a rare condition, the skin disorder known as hidradenitis suppurativa or acne inversa is actually a common skin condition, affecting as many as 1 in 100 people. It’s not contagious or caught through sexual transmission, so there is no link to personal hygiene or anything under your control. With proper care and treatment, you can control and reduce your symptoms and outbreaks, but there’s no known cure. So, what is hidradenitis suppurativa exactly?
This condition creates sores or lesions, most commonly on the skin in areas that often rub together, such as the armpits, groin, buttocks, and under the breasts. It can also occur on the back of the neck, thighs, or around the waist.
The hallmark signs of hidradenitis suppurativa are pea-sized (or larger) lumps in these areas that can be red, bloody, or oozing. The skin often becomes red and breaks open, and the lesions create discomfort. Hidradenitis suppurativa often emerges around puberty, and for unknown reasons, it affects women more often.
Cases of hidradenitis suppurativa typically start with a single, painful red lump or lesion under the skin and progress to multiple lumps and boils. These can become infected and sometimes leak unpleasant-smelling pus as they become infected.
Another common symptom is blackheads or connected, tunnel-like blackheads in pairs.
Healed lesions leave scars, and lesions may keep recurring in the same spot or move to new areas.
If left untreated, the disease can progress, and skin can become deeply abscessed and swollen, not to mention painful. The lesions or boils can become connected in tunnels under the skin, and scars can develop, making any movement of the area challenging, painful, and stiff.
Causes and Risk Factors of Hidradenitis Suppurativa
The exact cause of hidradenitis suppurativa is not well known or understood. Scientists once thought the condition was caused simply by blocked sweat glands. Now they know that the cause is likely both genetic and environmental. It's related to blocked hair follicles and specific genetic mutations that make certain people more likely to develop the condition.
In general, hidradenitis suppurativa occurs when hair follicles in areas of the skin that see lots of friction become clogged, inflamed, and infected/abscessed.
Risk factors for hidradenitis suppurativa include the following:
- Sex: Women tend to be at higher risk for the condition than men for unknown reasons.
- Family history: If someone in your family has the condition, you’re more likely to develop it yourself.
- Obesity: A higher BMI in the obese range seems to be linked to developing the condition
- Smoking: smoking can be linked to the occurrence of hidradenitis suppurativa
- Age: the condition often rears its head right before or around puberty, but the most common time for it to occur is in women between ages 18‒29.
Treatment options for hidradenitis suppurativa vary widely as the condition can be mild or quite severe and require more aggressive approaches.
First, a doctor will diagnose the condition through a physical examination, and in some cases, testing any pus that is present to rule out other infections. You may need a blood test, but doctors can often diagnose it by questioning the patient and visually examining the area and appearance of the affected skin.
While there is no cure for the condition, medications and lifestyle changes can help alleviate pain and symptoms. Medications are often prescribed, ranging from topical antibiotics to address the infection to oral antibiotics and possibly pain killers, in moderate or more severe cases.
Depending on the amount of tissue affected and the severity of the lesions, surgery can also be an option. The surgery itself can vary widely depending on each case and may entail using laser therapy to:
- Remove a single nodule, known as “punch debridement,”
- Remove the entire affected areas of skin, or
- Extract the tunnels under the skin by removing the top layer of the skin, allowing them to scar over and heal, known as “unroofing.”
Doctors may choose to make an incision and drain the infected areas instead. However, this is not considered a long-term fix since the areas will likely become inflamed again.
Diet and Lifestyle Habits for Hidradenitis Suppurativa
While there is no replacement for medical interventions, there are food and lifestyle habits that people with hidradenitis suppurativa should consider adopting to alleviate their symptoms.
- Avoid eating red meat, dairy, and any food high on the glycemic index.
- Quit smoking.
- Lose weight to help reduce any friction in affected areas.
- Wear loose-fitting clothing that doesn’t aggravate the skin.
- Warm baths or compresses can help reduce pain and inflammation.
- Use topical cleansers like acne and antibacterial cleansers to keep the areas clean and disinfected.
The best treatment options vary widely depending on the patient and the type and severity of the hidradenitis suppurativa. Seeing a qualified dermatologist is a must, as they can determine the best course of treatment for each case.