Hidradenitis Suppurativa

Definition:
Hidradenitis suppurativa or HS is a skin disease that affects areas bearing apocrine sweat glands and hair follicles; such as the underarms, groin and buttocks. It is more commonly found in women and can be present under the breasts.

Hidradenitis suppurativa is a chronic skin inflammation marked by the presence of blackheads and one or more red, tender bumps (lesions). The lesions often enlarge, break open and drain pus. Scarring may result after several occurrences.

The cause of hidradenitis suppurativa isn’t known. But it’s considered a severe form of acne (acne inversa) because it occurs deep in the skin around oil (sebaceous) glands and hair follicles. The parts of the body affected — the groin and armpits, for example — are also the main locations of apocrine sweat glands.

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Hidradenitis suppurativa tends to start after puberty, persist for years and worsen over time. There is no cure for hidradenitis suppurativa. But early diagnosis and treatment can help manage the symptoms and prevent new lesions from developing.

Other names for HS
Hidradenitis suppurativa has been referred to by multiple names in the literature, as well as in various cultures. Some of these are also used to describe different diseases, or specific instances of this disease.

*Acne conglobata – not really a synonym – this is a similar process but in classic acne areas of chest and back

*Acne Inversa (AI) – a new term which has not found favour.

*Apocrine Acne – a misnomer, out-dated, based on the disproven concept that apocrine glands are primarily involved

*Apocrinitis – another misnomer, out-dated, based on the disproven concept that apocrine glands are primarily involved

*Fox-den disease – a catchy term not used in medical literature, based on the deep fox den / burrow – like sinuses

*Hidradenitis Supportiva – a misspelling

*Pyodermia sinifica fistulans – an older term, considered archaic now, misspelled here

*Velpeau’s disease – commemorating the French surgeon who first described the disease in 1833

*Verneuil’s disease – recognizing the French surgeon whose name is most often associated with the disorder as a result of his 1854-1865 studies

Stages
HS presents itself in three stages.

1.Solitary or multiple isolated abscess formation without scarring or sinus tracts. (A few minor sites with rare inflammation; may be mistaken for acne.)

2.Recurrent abscesses, single or multiple widely separated lesions, with sinus tract formation. (Frequent inflammations restrict movement and may require minor surgery such as incision and drainage.)

3.Diffuse or broad involvement across a regional area with multiple interconnected sinus tracts and abscesses. (Inflammation of sites to the size of golf balls, or sometimes baseballs; scarring develops, including subcutaneous tracts of infection – see fistula. Obviously, patients at this stage may be unable to function.)
Sign and Symptoms:

Hidradenitis suppurativa commonly occurs around hair follicles where many oil and sweat glands are found, such as the armpits, groin and anal area. It may also occur in areas where skin rubs together, such as the inner thighs, under the breasts or between the buttocks. Hidradenitis suppurativa can affect a single area or multiple areas of the body.

Click to  SEE THE PICTURES
Hidradenitis suppurativa usually appears as one or more red, tender bumps that fill with pus. It commonly occurs where oil (sebaceous) and apocrine sweat glands are found, such as the armpits, groin and anal area.

 

Signs and symptoms of hidradenitis suppurativa include:

*Small pitted areas of skin containing blackheads, often appearing in pairs or a “double-barrel” pattern.

*One or more red, tender bumps (lesions) that fill with pus. The bumps often enlarge, break open and drain pus. The drainage may have an unpleasant odor. Itching, burning and excessive sweating may accompany the bumps.

*Painful, pea-sized lumps that grow under the skin. These hard lumps, which may persist for years, can enlarge and become inflamed.

*Painful bumps or sores that continually leak fluid. These open wounds heal very slowly, if at all, often leading to scarring and the development of tunnels under the skin.

For some people, the disease progressively worsens and affects multiple areas of their body. Other people experience only mild symptoms. Excess weight, stress, hormonal changes, heat or excessive perspiration can worsen symptoms.

Causes:
Hidradenitis suppurativa develops when the oil glands and hair follicle openings become blocked. When oils and other skin products become trapped, they push into surrounding tissue. Bacteria can then trigger infection and inflammation. It’s not known why this occurs, but a number of factors — including hormones, genetics, cigarette smoking and excess weight — may all play a role.

Sometimes hidradenitis suppurativa occurs with other diseases, such as Crohn’s disease, herpes simplex or Grave’s disease.

As this disease is poorly studied, the causes are controversial and experts disagree. However, potential indicators include:

*post-pubescent

*females are more likely than males

*genetic predisposition

*plugged apocrine (sweat) gland or hair follicle

*excessive sweating

*bacterial infection

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*sometimes linked with other auto-immune conditions

*androgen dysfunction

*genetic disorders that alter cell structure

*stress can bring on outbreaks

*being overweight makes it worse, however this condition is not caused by obesity and weight loss will improve but not cure it.

*cigarette smoking tends to encourage outbreaks as well

The historical understanding of the disease is that there is a misfunction in either the apocrine glands or hair follicles, possibly triggered by a blocked gland, creating inflammation, pain, and a swollen lesion. More recent studies imply there is an autoimmune component.

HS is not caused by any bacterial infection — any infection is secondary. Most cultures done on HS lesions come back negative for bacteria, so antibiotics should be used only when a bacterial infection has been confirmed by a physician.

Hidradenitis suppurativa is not contagious.

Screening and Diagnosis:
To make a diagnosis, your doctor may ask about your symptoms and medical history, examine your skin, and order blood tests. If pus or drainage is present, your doctor may send a sample of the fluid to a laboratory for testing. This test is known as a culture. Such tests may be necessary to rule out other skin conditions, such as tuberculosis of the skin, a carbuncle or a pilonidal cyst.
General Complications:
Hidradenitis suppurativa often causes complications when the disease is persistent and severe. These complications include:

*Sinus tracts or tunnels that connect and form a network under the skin. The tracts prevent the sores from healing and cause more sores to develop.

*Scars and skin changes. Severe hidradenitis suppurativa may leave thick, raised scars, pitted skin or patches of skin that are darker than normal (hyperpigmentation).

*Restricted movement. The disease may cause limited or painful movement, especially when it affects the armpits or thighs.

*Cellulitis. This potentially serious bacterial infection appears as an area of swollen, red skin that feels hot and tender and that may spread rapidly. Although the initial infection may be superficial, it eventually can affect the tissues underlying your skin or spread to your lymph nodes and bloodstream.

Severe complications:
Left undiscovered, undiagnosed, or untreated, the fistulas from severe stage-3 HS can lead to the development of squamous cell carcinoma in the anus or other affected areas.

Treatments:

There is no cure for hidradenitis suppurativa. But early treatment can help manage the symptoms and prevent new lesions from developing.
Treatments may vary depending upon presentation and severity of the disease. Due to the poorly-studied nature of this disease, the effectiveness of the drugs and therapies listed below is not yet clear, and patients should discuss all options with their doctor or dermatologist. Nearly a quarter of patients state that nothing relieves their symptoms. A list of treatments that are possible treatments for some patients is as follows.

*lifestyle

*changes in diet.

*warm compresses, baths (to induce drainage)
medication
*ntralesional corticosteroid injections (to reduce inflammation)

*oral antibiotics (to treat inflammation and bacterial infection)

*isotretinoin (Accutane), a prescription-only oral acne treatment (benefits for HS are very controversial, but it is generally considered to be ineffective)

*anti-androgen therapy

*sub-cutaneous injection or IV infusion of anti-inflammatory (anti-TNF-alpha) drugs such as infliximab (Remicade), etanercept (Enbrel), and adalimumab. This use of the drugs is not currently Food and Drug Administration (FDA) approved and is

*somewhat controversial, and therefore may not be covered by insurance.
Acitretin

*Zinc gluconate taken orally has been shown to induce remission
surgery (But Obesity, incomplete removal and ongoing skin infections can increase the chances that hidradenitis suppurativa returns, even after surgical treatment.)

*incision and drainage or lancing

*wide local excision (with or without skin grafting), or laser surgery

*radiotherapy

Self-care:
The following suggestions may help relieve discomfort, speed healing and prevent the infection from spreading:

*Apply a warm washcloth or compress to help reduce swelling.

*Gently wash the affected areas with antibacterial soap. After washing, apply an over-the-counter antibiotic.

*Wear loosefitting clothes and underwear to prevent skin irritation.

*Avoid shaving the affected areas to prevent skin irritation.

*Don’t smoke. Smoking can worsen symptoms and trigger new outbreaks.

Excess weight increases the number of areas where skin rubs together — for example, between skin folds — causing friction, increased perspiration and bacterial growth. Though weight loss won’t cure the disease, it may improve symptoms.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://en.wikipedia.org/wiki/Hidradenitis_suppurativa
http://www.mayoclinic.com/health/hidradenitis-suppurativa/DS00818/DSECTION

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