Hidradenitis suppurativa, HS or acne inversa is a painful skin disease causing abscesses and scarring of the skin. This chronic or long-term condition is linked to inflammation of apocrine sweat glands, and is not contagious.
HS often affects areas around the groin, bottom and anus, buttocks, breasts and armpits.
The condition can spread to other areas including the back, neck, face and front or back of the legs.
This condition affects as many as one in 100 people, though it may be under diagnosed due to some people being too embarrassed to see a doctor about it.
The British Association of Dermatologists says hidradenitis is more common in women and often begins in the 20s or 30s.
Causes of hidradenitis suppurativa
The exact cause of hidradenitis suppurativa is not known but experts believe inflamed or blocked apocrine sweat glands and hair follicles may be to blame.
Hormones may play a part in this condition as it is not seen before puberty or after the menopause.
The condition may run in families, but not in every case.
Bacteria is found in hidradenitis spots but it is not clear whether this contributes to causing the condition or is a just a symptom of it.
Hidradenitis has also been linked with Crohn’s disease, immune disorders, acne and pilonidal sinus abscess of the spine.
Symptoms and diagnosis of hidradenitis suppurativa
Hidradenitis diagnosis will involve an assessment of affected areas of skin and their location.
A doctor or a dermatologist (skin specialist) will look for blackheads, red boil-like lumps, pus spots, cysts, areas leaking pus and scarring from previous outbreaks.
People with hidradenitis may also develop a pilonodal sinus, a small tunnel-like hole in the skin, often at the top of the buttocks where they separate.
Swabs may be taken from affected areas for laboratory testing to determine which germs are present.
Hidradenitisis is graded into three stages, called Hurleys clinical staging.
- Stage 1 is where there are one, or a few, isolated abscesses without scarring or sinus tracts
- Stage 2 is where someone has recurrent abscesses in more than one area and sinus tracts are starting to form
- Stage 3 is defined as having widespread abscesses with multiple and linked sinus tracts. There may also be severe scarring and continuous pus leakage
For some people, their HS will remain in stage 1, while for others it may progress to later stages.
Treatment for hidradenitis suppurativa
Hidradenitis cannot be cured but treatment may alleviate symptoms, depending on the stage of the condition.
Poor skin hygiene is not a cause of hidradenitis, but patients may be prescribed a special antiseptic body wash to help fight bacteria in the spots and boils.
If the condition flares up or worsens suddenly, doctors may prescribe a course of antibiotics. Prolonged antibiotic use of around three months may be advised.
Specialist dermatologists may recommend retinoids - vitamin A-based drugs - such as isotretinoin or acitretin.
Oral corticosteroids may be prescribed.
If a woman's hidradenitis becomes worse around her period, the Pill may be prescribed.
In severe cases, immune system suppressing treatments may be considered if the benefits are thought to outweigh the risks in individual cases. These include ciclosporin and the biologics infliximab and adalimumab.
Surgical or laser treatment may be needed for some abscesses or boils.
Although being obese and being a smoker do not cause hidradenitis, they are believed to worsen it. Losing weight and quitting smoking may be advised by doctors.
Other measures which may help include choosing loose-fitting clothes, joining support groups and reducing stress.
The condition can be distressing, debilitating and affect a person's quality of life. There is also a risk of depression developing. Seek medical advice if you have concerns.