Hidradenitis Suppurativa

Hidradenitis Suppurativa is a long-term (chronic) skin condition which we can treat with laser at our clinics in London, Altrincham, Bury, Leeds and Liverpool. The cause is unknown. Inflammation of the apocrine sweat glands-bearing areas leads to painful and recurrent boils and abscesses. An abscess is a collection of puss. Suppuration means formation or discharge of puss. These areas commonly groin and armpits leak pus and are difficult to heal. Eventually scarring can occur. Treatments include antibiotics, surgical drainage of the abscess and, sometimes surgical removal of the affected skin.

Apocrine sweat glands are larger than eccrine sweat glands and are found only in certain areas of the body i.e underarms, groin, the genital region around the nipples and under the breasts. The main difference between apocrine and more common eccrine sweat glands is that apocrine glands release their secretions into the hair follicles rather than directly onto the skin. Apocrine glands secret a thick milky fluid which contains pheromones rather than eccrine secretions which contains salts, water and other chemicals in the form of sweat which is secreted directly on to the skin through pores.

The cause is not well understood but is thought to happen due to a blockage of the hair follicle or the sweat glad openings themselves. This blockage could be from sweat itself, or skin secretions such as sebum from the sebaceous glands.

Commonly the problem affects the groin and armpits. Other areas affected can be under the breasts, the vulva, the scrotum, the buttocks and perineum. Women tend to develop the condition more commonly in the arm pits and groin whilst men more commonly develop the condition around the perineal area.

Hidradenitis Suppurativa usually starts with a single inflamed, boil-like, firm, raised skin lump (nodule). Sometimes this stage can result in itching, but usually there is discomfort. The nodule either slowly disappears or develops into a collection of pus or abscess which is usually very painful.

The wounds caused by the boils and abscesses heal poorly with scarring. In severe cases, the puss tunnels down under the skin surface. The tunnels (channels) formed are called sinus tracts. Multiple areas can become linked under the skin surface, by the network of interconnected sinus tracts causing the overlying skin to feel hard and lumpy (indurated). This means the inflammation and infection travels deeper and becomes more widespread. The healed areas can be full of thick scar tissue which can be unsightly.

There is a UK base help group for HS patients HS Trust.org

Hurley’s Staging can be used to describe the severity of the disease:

• Stage 1 – Either single or multiple areas affected, but the abscesses are separate from each other. There is no scarring and no sinus tract formation.
• Stage 2 – Involves recurrent abscesses which can be single or multiple. Although there are sinus tracts, the affected areas are usually widely spread.
• Stage 3 – Generally, large areas are affected with multiple interconnected sinus tracts and abscesses.

Medical Treatments include:

• Topical anti-acne antibiotics and benzoyl peroxide. Antibiotics to kill the bacteria, benzoyl peroxide acts as an antibacterial agent whilst drying the skin and encouraging the shedding of dead skin cells helping to prevent blockage of the pores.
• Short courses of antibiotics. Usually used when there are new abscesses the aim being to stop the spread of infection.
• Prolonged courses of antibiotics. These are usually used for their anti-inflammatory action.
• Use of the Pill, usually Dianette or Yasmin in order to lower male hormone production.
• Retinoids (Acitretin, Neotigason). Vitamin A based. Prescribed by specialist where other medicines have not been effective. These stop the secretions of sebum from the sebaceous glad. There are uncommon -1 in 1000 side effects of photosensitivity with these drugs.
• Corticosteroids such as Prednisolone may be used to reduce inflammation.
• Medicines that effect the immune system again used to reduce inflammation. These need to be prescribed by a consultant and carefully monitored examples are Remicade and Dapsone.

Surgical Treatments:

• Incision and drainage – Piercing and draining a hard abscess this is usually done in stage 1 followed by a course of antibiotics
• Wide scale excision of the affected area. Usually done is stage 2 and 3. For stage 2 the sinus tracts are usually removed. In stage 3 the operation needs to be more extensive, as the tracts and scarring go deeper and larger areas are involved.