Hidradenitis Suppurativa

Hidradenitis suppurativa or also known as acne inversa is a skin condition that runs a chronic course. It is characterised by inflamed skin lesions that can resemble multiple boils and it is highly recurrent. Being three times more common in women than in men, the condition typically appears at sites which have abundant sweat glands such as the underarms, groin area and under the breasts. Hidradenitis suppurativa may be genetic and is heavily influenced by certain factors such as alcohol, excessive body weight, smoking, and consuming diets high in fat.

With that said, the incidence of hidradenitis suppurativa is higher in people with obesity. Obesity does not cause the emergence of hidradenitis suppurativa, but it can definitely worsen the symptoms and cause recurrent flare-ups. We shall look at some crucial aspects of the disease and later we shall see into hidradenitis suppurativa treatment.

Diagnosis of hidradenitis suppurativa is fairly straightforward, that is to say, clinical observation would suffice. There are no specific tests required and neither is a biopsy necessary. Clinically, three key areas are required to diagnose the condition; 

  • Typical skin changes; the presence of nodules whether inflamed or not, sinus tracts, abscesses and scarring.
  • Typical distribution: underarm, around the genitals,  around the buttocks, anal area, or under the breasts.
  • Recurrence of about 2 episodes occurring in a span of 6 months. 

For an accurate diagnosis, all of these must be present. Additional family history may strengthen the furthermore of the diagnosis. If you are concerned with your skin condition, it is best for you to consult a doctor, get a proper diagnosis before commencing on the necessary treatment.

Treatment of hidradenitis suppurativa consists of medical treatment, such as antibiotics, retinoids, corticosteroids, immunosuppressants among others. Surgery is also done, to remove the area of active disease, however with the variable outcome, with 33% of recurrence, and also to drain any abscesses, to reconstruct the area with extensive scarring, and to eliminate the sinuses that have developed.

Being a chronic disease, it is known for its persistence and resilience to make an appearance despite all the medications targeted at it. Therefore, conservative treatment and lifestyle changes may go a long way in helping to keep the symptoms and recurrence of hidradenitis supurativa in proper control and finding long-lasting relief.

Some dermatologists agree that weight loss would probably be the most effective way to control hidradenitis suppurativa. The start of the disease process begins with the blockage of follicles in the skin. Having excess weight means there will be extra areas on the body where the skin will rub against each other, namely between the skin folds. These areas will have more friction, damp with sweat, and prolific bacterial growth, all of which favours the flare-ups of hidradenitis suppurativa. Hence, losing weight will reduce these areas and together with it, reducing flare-ups. And there will also be an added advantage to it. Hidradenitis suppurativa is documented to have increased risk in developing heart disease, stroke and diabetes. Therefore, losing weight and consuming a well-balanced diet can reduce the risks of getting these chronic debilitating illnesses.

And lastly, patients need to follow these simple steps in order to ensure all risks of developing flare-ups will be minimized.

  • Maintaining good hygiene especially over the common sites
  • Proper use of soaps, antiseptics and antiperspirants
  • Applying a warm compress to the areas with saltwater
  • Wear loose-fitting clothing
  • Stop smoking

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