Hidradenitis suppurativa is a debilitating inflammatory skin disorder characterized by blackheads and red and tender bumps (lesions) on the skin. The condition adversely affects the apocrine or sweat glands. The bumps often grow bigger in size, breaking open and draining pus. Recurrences of hidradenitis suppurativa may result in scarring.

Although no exact cause of hidradenitis suppurativa has been established so far, it is generally perceived to be an aggravated condition of acne (acne inversa) as it deeply affects the skin around sebaceous glands and hair follicles.

Hidradenitis suppurativa has a tendency of developing after puberty and persisting for the period of years before worsening over the periods. Although no cure is available for hidradenitis suppurativa, it is possible to manage its symptoms and prevent development of new lesions with early diagnosis and treatment.

Signs and symptoms

Following are the signs and symptoms of hidradenitis suppurativa:

Presence of blackheads either in groups or a "double-barrel" pattern on the skin.

Single or several red and tender bumps or lesions containing pus. The bumps, which may be itchy and also accompanied by burning and sweating, start draining pus on becoming larger in size and breaking open.

Growth of painful and hard lumps similar to size of a pea on the skin. Such lumps that may grow larger and cause inflammation may continue to remain on the skin for several years.

Painful bumps or sores on the skin, releasing fluid more often. Such open wounds take a long time to heal and may leave scarring and result in the formation of tunnels under the skin.

The condition in some people continues to grow worse affecting large areas of body. On the other hand it shows mild symptoms in other people. Over weight, tension, hormonal changes, heat or sweating may contribute in worsening of the symptoms.

Causes of hidradenitis suppurativa

Although the exact cause of hidradenitis suppurativa remains unknown, it is believed to be occurring with the blockage of sebaceous (oil) glands and hair follicle openings. The apocrine gland ducts and perifolliculitis surrounding the ducts are obstructed due to follicular occlusion resulting in the condition of Hidradenitis suppurativa.

Some people are thought to be genetically predisposed for the condition. Hidradenitis suppurativa seems to be more commonly affecting women. Hidradenitis suppurative does not usually occur before puberty because the sweat glands do not become active at this age. However, it can occur at any age after puberty. The rate of incidence of hidradenitis suppurative is found to be higher among cigarette smokers than those who don't smoke.

Several factors such as hormonal changes, genetics, cigarette smoking and overweight contribute to the development of the condition. The enlargement of sweat glands, tension, menstrual period, intense heat and excessive sweating are also said to be the factors behind the occurrence of hidradenitis suppurativa. Sometimes it is believed to be associated with several other conditions like Crohn's disease and herpes simplex.

When to seek medical advice

Some self-care measures can be sufficient to treat some mild cases of hidradenitis suppurativa. But if the condition does not go away and continues to persist even after two weeks, affects large part of body or results in pain, you will need to go to a dermatologist. In such cases the condition can be managed through medical treatment like prescription medications or operations.

Screening and diagnosis

In order to diagnose your problem your doctor may look for the symptoms and ask you about medical history besides examining your skin and conducting your blood test. In case of presence of pus or drainage, your doctor may feel a need of carrying out laboratory testing of the fluid sample. Such tests may be required to ensure accurate diagnosis of the condition and rule out conditions like skin tuberculosis or a carbuncle.

Complications

The persistent and severe hidradenitis suppurativa often leads to several other complications such as:

Creation of sinus tracts or tunnels connecting and forming a network under the skin. The tracts not only cause delay in healing of the sores but also give rise to chances of development of more sores.

Severe form of hidradenitis suppurativa may cause the lesions to become thicker and lead to creation of scars and dark patches on the skin.

The condition may restrict your movement particularly when it occurs on armpits or thighs.

The condition may cause some serious bacterial infection with swelling and redness of the skin that may feel hot and spread quickly to other areas of the body. The infection may seem superficial, but it can harm the tissues underlying your skin besides affecting lymph nodes and spreading to bloodstream.

Treatment for Hidradenitis suppurativa

It is always good to go for hidradenitis suppurativain treatment. It the initial stages because any delay may lead to scarring. However, accurate and correct diagnosis is very essential.

The mild to moderate cases can initially be treated with topical therapy such as topical retinoid. Moist heat or incision can be sufficient to treat simple cases.

The treatment of severe cases with scarring may necessitate use of surgical method to take out scars and underlying diseased tissues. The operated areas are often left to recover without the necessity of skin grafting. In some severe cases, the involved area may be cut out and replaced with skin of other area of body through grafting.

Treatment may include the following:

Topical Antibiotics can be prescribed for quick recovery from condition of hidradenitis suppurativa.

Systemic antibiotics are required when the condition flares up and a patient undergoes severe case of hidradenitis suppurativa. Antibiotics, if used for a long time, may avoid further aggravation of the condition and help check its recurrence in future.

Sometimes surgery is needed for draining out infected areas or removing the scarred tissues or large part of skin affected by the condition.

Higher doses of systemic steroids can be used as additives to antibiotics. Such steroids can help reduce the inflammatory process effectively.

Use of oral retinoid medications can be a good choice to check oil gland functions and prevent hair follicles from getting plugged.

Nonsteroidal anti-inflammatory drugs can be used to get relief from pain and reduce swelling.

Corticosteroids or immunosuppressant drugs can also be used for speedy recovery from the condition.