Hidradenitis suppurativa is a chronic, scarring disease that affects the apocrine, or sweat glands. It is a common skin condition but is frequently misdiagnosed. Hidradenitis suppurativa does not occur before puberty. Most people are between 20 to 40 years old when they develop hidradenitis suppurativa. It can be a disabling and distressing skin condition.
Cause of Hidradenitis Suppurativa
The exact cause of hidradenitis suppurativa is disputed. Because it looks similar to acne, some investigators believe that it is caused by the formation of keratin plugs in the follicles. Because hidradenitis suppurativa occurs in areas that contain apocrine, or sweat, glands, other investigators believe that it is caused by a blockage of the apocrine gland. In either case, the plugged gland or follicle becomes larger, ruptures, and becomes infected. Obesity and cigarette smoking may be triggering factors.
Appearance of Hidradenitis Suppurativa
Hidradenitis suppurativa occurs in areas of the body that contain sweat glands including the armpits, groin, buttocks, scalp, and under the female breast. When the condition is mild it may only present as a cluster of 2 or 3 blackheads that communicate under the skin. Once the disease begins, it gets progressively worse. The extensive, deep inflammation leads to painful abscesses. These heal incompletely and cause cord-like scars on the skin. The infection can progress under the skin in tracts linking the abscesses. These boils can be very painful and restrict movement of the affected area.
Diagnosing Hidradenitis Suppurativa
Hidradenitis suppurativa is diagnosed clinically based on its appearance. There are no lab tests or biopsies that establish the diagnosis. In the early stages, it can be misdiagnosed as an isolated boils. Many people are embarrassed by the multiple infections thinking they are ingrown hairs in sensitive areas. They do not go to the health care provider until the boils have become numerous or intolerable.
Treatment of Hidradenitis Suppurativa
Treating hidradenitis suppurativa is difficult. It is best treated in the early stages before extensive scarring develops. However, it must be diagnosed correctly. The following are some of the treatment options:
Antibiotics - Oral antibiotics may help suppress the inflammation especially in mild cases, but they do not cure the disease. The same antibiotics that are used for acne are used for hidradenitis suppurativa, only in higher doses. These antibiotics include erythromycin, tetracycline, minocycline, and doxycycline. Topical antibiotics do not help.
Isotretinoin (Accutane) - Isotretinoin may be helpful in mild cases, but the response is unpredictable. Sometimes isotretinoin is used to reduce the size of the affected areas prior to surgery. Isotretinoin does have significant side effects and must not be used by pregnant women.
Steroid injection - Injecting a steroid into an inflamed lesion is sometimes helpful. The injection helps reduce inflammation and may be used if an area is especially painful. Steroid injections are normally combined with other treatments.
Surgery - In moderate to severe cases, surgery is the most definitive option. Taking out only the immediately affected area only leads to recurrence of the disease. The treatment of choice is called wide local excision. In this procedure, the affected area and surrounding normal tissue are surgically excised. The excision is not stitched back together but left open to heal from the inside out. Skin grafts may be placed in the excised area to speed healing.