Hidradenitis suppurativa is an inflammatory skin disease that is characterised by recurrent boil-like lumps (abscesses) that culminate in pus-like discharge, difficult-to-heal open wounds and scarring. It commonly occurs on apocrine sweat gland-bearing skin such as in the groin, the underarms and under the breasts. It is also known as 'acne inversa'.
What causes hidradenitis suppurativa and who gets it?
The exact cause of hidradenitis suppurativa remains unclear. What is understood is that the condition is a disorder of follicular occlusion. This begins with follicular plugging that obstructs the apocrine gland ducts and perifolliculitis around the ducts. This is followed by rupture of the follicular epithelium, bacterial infection and formation of sinus tracts between abscesses under the skin, all which lead to the characteristic symptoms and signs of hidradenitis suppurativa.
What is the treatment of hidradenitis suppurativa?
Medical management of hidradenitis suppurativa is difficult. The aim is to catch the disease in its early stages and treat and control these milder forms. Weight loss in obese patients and smoking cessation are recommended.
General measures include:
Wash with antiseptics or acne preparations to reduce skin carriage of commensal bacteria. Hydrogen peroxide solution and medical grade honey have been found helpful.
Wear loose fitting clothing to avoid friction.
Follow a low glycaemic diet, and aim for ideal body weight.
Medical management includes:
Topical anti-acne antibiotics such as clindamycin or erythromycin applied to affected areas in combination with benzoyl peroxide.
Short course of oral antibiotics for acute abscesses (red, hot painful discharging lump) due to staphylococcal infection. Flucloxacillin or dicloxacillin are the most suitable, except in the case of penicillin allergy.
Prolonged courses of tetracycline or metronidazole (minimum 3 months) for their anti-inflammatory action.
Three-month courses of the combination of clindamycin and rifampicin may be effective.
Trial of oral contraceptive pill for 12 months or more -- usually Diane-35 or Estelle 35, which contain moderate oestrogen and cyproterone acetate. The antiandrogenic diuretic spironolactone may also be of benefit.
Oral retinoids (vitamin A derivatives) for 6 to 12 months, especially isotretinoin, which are very effective for acne, may also help hidradenitis suppurativa.
Systemic corticosteroids or intralesional corticosteroids (injections directly into the nodules) may reduce severe inflammatory lesions.
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