September 10, 2023, 6:05 am | Read time: 6 minutes
Hidradenitis suppurativa often comes with significant distress. It causes pus-filled swellings and painful inflammations in sometimes intimate areas. Many sufferers are embarrassed by their skin condition, compounded by the fact that it is incurable. FITBOOK author Laura Pomer spoke with a dermatologist about the topic.
Overview
Hidradenitis Suppurativa – What Is It?
Hidradenitis suppurativa is a chronic skin condition that usually emerges before the age of 20. “Inversa” comes from Latin, meaning “reversed.” Thus, hidradenitis suppurativa appears on inverse, or underlying, body areas.
The condition manifests with abscesses (pus-filled boils) and inflammations. Additionally, it leads to so-called fistulas, which are connections between the skin and other organs. Symptoms frequently occur in areas where skin folds form, such as the armpits, groin, and intimate areas, and often affect the skin under the breast fold. For diagnosis, the type of skin abnormalities is relevant, as well as their location and whether the reported inflammations are recurrent.
The symptoms are caused by a keratinization disorder of the hair follicles. “The openings of the follicles clog and thicken until they can eventually burst,” explains Dr. Golüke in an interview with FITBOOK. When parts of hair and sebum enter the tissue, inflammation is likely. The areas can become painful.
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Shame Among Those Affected, Often with Consequences
For those affected, the condition can be embarrassing, especially since the oozing areas can appear as wet spots on clothing and emit an unpleasant odor. This can lead to social withdrawal and a reluctance to seek treatment, which can exacerbate the condition. It’s important to have abscesses examined to rule out the possibility of tumors.
The problem doesn’t end there. If sufferers withdraw and avoid treatment, the condition can worsen. It’s crucial to have abscesses examined to rule out the possibility of a tumor.
Hidradenitis Suppurativa – What Is It?
Hidradenitis suppurativa is a chronic skin condition that usually emerges before the age of 20. “Inverse” comes from Latin, meaning “reversed.” Thus, hidradenitis suppurativa occurs on inverse, or underlying, body areas.
The condition is characterized by abscesses (pus-filled boils) and inflammations. Additionally, it leads to so-called fistulas, or connections between the skin and underlying organs. These symptoms often appear in areas such as the armpits, groin, and intimate areas, and frequently affect the skin under the breast fold. For diagnosis, it’s important to identify the type of skin abnormalities to rule out the possibility of a tumor.
The symptoms are caused by a keratinization disorder of the hair follicles. “The openings of the follicles clog and thicken until they can eventually burst,” explains Dr. Golüke to FITBOOK. When parts of hair and sebum enter the tissue, inflammation is likely. The areas can become painful.
Read more: Psoriasis – Triggers, Progression, and Treatment Options
Shame Among Sufferers, Often with Consequences
For those affected, the condition can cause significant embarrassment, especially since the oozing areas can appear as wet spots on clothing and emit an unpleasant odor. This can lead to social withdrawal and a reluctance to seek treatment, which can worsen the condition. It’s important to have abscesses examined to rule out the possibility of a tumor.
The problem doesn’t end there. If sufferers withdraw and avoid treatment, the condition can worsen. It’s crucial to have abscesses examined to rule out the possibility of a tumor.
Problems with Diagnosis
Even if sufferers manage to seek medical help, a confirmed diagnosis can be difficult to obtain. The problem is that many doctors are unfamiliar with the condition or misinterpret the symptoms. As a result, patients often spend years going from doctor to doctor before receiving help. In essence, hidradenitis suppurativa is a case for a dermatologist.1
Prevalence and Causes of Hidradenitis Suppurativa
There is no reliable statement on the prevalence of hidradenitis suppurativa. Many uncertainties remain about its causes. According to the dermatologist, women are more often affected than men, with a suspected hormonal influence. “It is also now believed that an autoimmune component may play a role,” explains Dr. Golüke. Therefore, hidradenitis suppurativa is increasingly being referred to as an autoimmune disease. Relatively often, people who also suffer from chronic inflammatory bowel diseases are affected.
What Worsens Hidradenitis Suppurativa?
There is more certainty regarding the factors that can exacerbate hidradenitis suppurativa or trigger flare-ups. These include increased (psychological) stress, unhealthy habits such as smoking, a high-sugar diet, and severe obesity. Additionally, the onset of symptoms can be exacerbated by factors such as tight, chafing clothing or various hair removal methods.
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Treatment of Hidradenitis Suppurativa
“Hidradenitis suppurativa is difficult to treat,” admits Dr. Golüke. There is no universally recommended treatment path – the approach depends on the severity of the symptoms.
Medication Therapy
Medication is often the first line of treatment. The most common options include antiseptic ointments or solutions for local application to the affected areas.
Some patients, as with other forms of acne, are also prescribed a specific antibiotic. Additionally, according to Dr. Golüke, in severe cases, treatment attempts with isotretinoin are common. This medication works by clogging and thickening the sebaceous glands, which can eventually burst. Close monitoring is important during such treatment, especially for female patients, as isotretinoin is highly teratogenic.2 This means that taking it can lead to severe and irreversible damage or malformations in a child.
“There are now newly approved so-called biologics that are prescribed through university clinics,” reports the dermatologist to FITBOOK. Such biotechnological drugs work by blocking certain proteins in the immune system that cause inflammation.
Surgery for Hidradenitis Suppurativa
In severe cases where conservative treatments do not provide relief, surgery is necessary. The abscesses are surgically opened and drained. If the affected areas are small, they can be stitched up afterward. In cases of widespread infection, the surgical wounds are often left to heal open.
Is Hidradenitis Suppurativa Curable?
Complete healing is not possible. It is important to have abscesses examined to rule out the possibility of a tumor. Additionally, sufferers should avoid known trigger factors, such as quitting smoking and reducing severe obesity.