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What is Hidradenitis suppurativa? Hidradenitis suppurativa is also known as Verneuil’s disease or acne inversa. It is a chronic disease of the hair follicles causing the formation of nodules, abscesses, and scarring. It affects 0.05 to 4.10% of the population, occurring mostly in young African American or biracial women.
What does Hidradenitis suppurativa look like?
Hidradenitis suppurativa occurs predominantly in intertriginous areas, with the axilla being the most common site. It can also occur in areas of frequent skin compression and friction. While the presentation may vary, most patients have similar clinical features.
- Onset after puberty as painful and pruritic solitary nodules that are often mistaken for a boil. Some may experience localized pain and pruritus and fatigue prior to the development of the nodule.
- Recurrence of nodules.
- Progression of disease into expanding abscesses forming sinus tracts.
- Draining of the sinus tracts as multi-headed open comedones with discharge and odor.
- Destruction of sebaceous glands and hair.
- Scarring of varying severity. The formation of thick fibrotic bands of scar tissue may restrict mobility and cause obstruction of the lymphatic system.
Hidradenitis suppurativa can significantly impact the quality of life and can lead to depression and impairment of the person’s social life and career. There is a significant increase in the risk of substance use and suicide in those with Hidradenitis suppurativa.
What causes Hidradenitis suppurativa?
The development of Hidradenitis suppurativa points to dysfunction of the immune system causing hyperkeratosis and subsequent rupture of the hair follicle and inflammation of the apocrine gland.
Risk factors include:
- Genetic predisposition- 30 to 40% of patients have at least one affected family member.
- History of smoking.
- Unique skin flora.
- Earlier onset associated with more widespread disease.
The presence of Hidradenitis suppurativa is associated with an increased incidence of comorbidities such as severe acne vulgaris, psoriasis, diabetes, hyperlipidemia, myocardial infarction, and inflammatory bowel disease (especially Crohn’s Disease).
How is Hidradenitis suppurativa treated?
Early treatment of Hidradenitis suppurativa is recommended to stop progression and prevent complications by treating the existing lesions and reducing the formation of new ones. Treatment can also minimize the risk of the associated psychological burden and is determined by the severity of the disease.
Management of Hidradenitis suppurativa can include:
- Skincare plan to reduce potential triggers.
- Wound care education.
- Pain control in the form of topical lidocaine, ice packs, and oral medication
- Topical medications such as antibiotics to treat any infections and resorcinol to unclog the follicles and reduce inflammation.
- Oral antibiotics.
- Oral retinoids, usually acitretin, in patients with concomitant acne.
- Adalimumab- a biologic that reduces abscesses and nodules in moderate-to-severe disease. It can be prescribed to patients 12 years and older.
- Intralesional corticosteroid injections
- Laser hair removal
- Surgical interventions such as punch debridement, excision and drainage, wide excision, and laser surgery.
Source: Goldburg, S. R., Strober, B. E., & Payette, M. J. (2020). Hidradenitis suppurativa. Journal of the American Academy of Dermatology, 82(5), 1045–1058. https://doi.org/10.1016/j.jaad.2019.08.090