Hidradenitis Suppurativa

What is hidradenitis suppurativa? 

Hidradenitis suppurativa is a chronic and stubborn disease centred on inflammation of the large specialised sweat glands (apocrine glands) that are found mainly in the armpits and groins. These areas show a distinctive mixture of boil-like lumps, areas leaking pus, and scarring.

What causes hidradenitis suppurativa?

It is still not clear why the apocrine sweat glands are affected like this in some people, but mechanical blockage plays a part. As the secretions cannot escape, the tubes containing them may swell up and burst, or become infected.

Contributory factors include the following:

Hormones are involved in the control of apocrine sweat glands and certainly play a part in the disease. Hidradenitis suppurativa affects women more often than men. It does not start before puberty or after the menopause. It may get better during pregnancy, but is often worse before menstrual periods. Some patients do well with hormone treatments (see below). 
Bacteria play a part too, but a variety of germs, and not just one special type, is found in the spots. It is not clear whether they cause the disease, or just flourish within it. 
There may be a link with acne. 

Is hidradenitis suppurativa hereditary?

Hidradenitis suppurativa sometimes runs in families, and some patients or family members may also have had bad acne, or a chronic abscess at the base of the spine (a pilonidal sinus).

What are the symptoms of hidradenitis suppurativa?

Hidradenitis suppurativa can be itchy, but is usually painful, and the lumps hurt if they are pressed.

What does hidradenitis suppurativa look like?

The severity of hidradenitis suppurativa varies from person to person. The main areas to be affected are the armpits, and the skin around the genitals - in the pubic area and in the groins. The skin around the back passage, on the upper buttocks and thighs, and below the breasts, can be affected too.

In these areas, the skin shows a variable mixture of blackheads, red lumps looking like boils, pus spots, cysts, and areas that constantly leak pus (sinuses). The abscesses can even burrow into nearby structures. As time goes by, more and more scarring appears.

How will hidradenitis suppurativa be diagnosed?

The diagnosis is made from the appearances of the rash and by taking into account the areas of distribution.  Your doctor may take swabs from the area to see which type of germ is present.

Can hidradenitis suppurativa be cured?

No, it usually persists for many years, but may disappear eventually. Treatment usually helps even though it cannot switch the hidradenitis off once and for all.

For information on available treatments please visit this page on the website of the British Association of Dermatologists.

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