Hidradenitis suppurativa is inflammation of the hair follicles in the skin under the arms, in the groin, and around the nipples and anus, resulting in scarring, inflammation, and painful accumulations of pus under the skin.
The cause of hidradenitis suppurativa is not known.
Bumps that look like acne form on the skin, followed by painful abscesses and sinus tracts.
To diagnose hidradenitis suppurativa, doctors examine the skin.
Treatment depends on severity but may include creams applied to the skin, antibiotics and other medications taken by mouth, and surgical procedures.
Hidradenitis suppurativa develops in some people after puberty when the hair follicles (the pores in the skin where hair grows) under the arms, in the groin, and around the nipples and anus are chronically blocked and become inflamed. The hair follicles may swell and form bumps that look like acne. Doctors do not know why the blockage occurs, but it is not related to poor hygiene, to the use of deodorants or powders, or to underarm shaving. Obesity can aggravate or worsen hidradenitis suppurativa.
The blockage causes the hair follicles to swell and rupture, sometimes leading to infection by various bacteria. The abscesses (pus-filled pockets) that result are tender, painful, and foul smelling, can grow deep into the skin, and tend to reappear if they heal. After the abscesses heal and reappear repeatedly, the skin in the area becomes thick and scarred. Often, permanent channels (called sinus tracts) form between the abscess and the skin surface and drain pus.
This person in this photo has multiple cordlike linear structures (called sinus tracts), which suggests that hidradenitis suppurativa is moderate in severity.
Photo courtesy of Karen McKoy, MD.
This photo shows a person who has both scarring and abscesses resulting from moderate hydradenitis suppurativa.
© Springer Science+Business Media
This photo shows chronic abscesses (for example, the blue arrow) and sinus tracts (black arrows) resulting from severe hidradenitis suppurativa.
© Springer Science+Business Media
This person in this photo has multiple cordlike linear structures (called sinus tracts), which suggests that hidradenitis suppurativa is moderate in severity.
Photo courtesy of Karen McKoy, MD.
This photo shows a person who has both scarring and abscesses resulting from moderate hydradenitis suppurativa.
© Springer Science+Business Media
This photo shows chronic abscesses (for example, the blue arrow) and sinus tracts (black arrows) resulting from severe hidradenitis suppurativa.
© Springer Science+Business Media
Hidradenitis suppurativa may cause only a few abscesses and be mild or may cause many abscesses and sinus tracts and be severe. Hidradenitis suppurativa can affect a person's quality of life because it causes pain and because the foul odor may cause embarrassment.
Utambuzi wa Hidradenitis Suppurativa
Examination of the skin
Culture of abscesses
Hidradenitis suppurativa abscesses resemble other skin abscesses. Doctors base the diagnosis on an examination of the skin, noting the location of the bumps and abscesses and determining whether they heal and reappear often.
Doctors sometimes take samples of pus from deep abscesses and have the bacteria identified by a laboratory (culture).
Matibabu ya Hidradenitis Suppurativa
Depends on severity
For people with a mild case of hidradenitis suppurativa, a doctor injects corticosteroids into the area and prescribes antibiotics, such as tetracycline, minocycline, erythromycin, or clindamycin, to be taken by mouth (orally) for about 7 to 10 days. Clindamycin and resorcinol creams applied to the skin (topically) are also given, and people should wash the area with benzoyl peroxide. All of these medications may be used together or alone.
For people with a moderate case of hidradenitis suppurativa, a doctor gives the same oral antibiotics as for mild cases, and sometimes rifampin (another oral antibiotic), but for a longer period (2 to 3 months). Doctors may give women medications that block the effects of male sex hormones, such as oral contraceptives, spironolactone, or finasteride. The doctor may cut open the abscesses to drain the pus. Sinus tracts are opened and drained.
For people with a severe case of hidradenitis suppurativa, a doctor gives infliximab (by vein) or adalimumab or secukinumab (by skin injection) to reduce inflammation. Isotretinoin or acitretin (by mouth), taken for several months, may reduce inflammation. If the disorder continues, a doctor cuts out the involved area and then repairs the skin or does a skin graft. Laser treatment to remove the damaged skin or hair may also be done.
Although good hygiene will not cure the condition, all people with hidradenitis suppurativa should maintain good skin hygiene and treat the skin gently. Psychological support and avoiding high-glycemic foods, which are high in simple or processed carbohydrates and sugars, may help, as may losing weight.
