ENCYCLOPEDIA

Definition

Hidradenitis suppurativa (HS) is when recurring inflamed nodules (small, solid lumps) and cysts (fluid-filled mass) appear in the armpits and groin. These lesions may also be found under the breasts and even around the nipples and anus.

The lesions start as plugged pores in the sweat and oil glands. The plugging allows material to build up under the skin. The body's inflammatory system attacks these materials, causing nodules and cysts to form. These lesions can rupture under the skin and form large, painful abscesses. When on the skin's surface, they can form draining sinuses.

Sweat Gland

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The affected areas may have a bad smell and may eventually heal and leave scars. Because HS worsens with time, it is important to treat this condition as early as possible. Having another infection in these lesions is rare. When it does occur, the bacterium that is almost always present is Staphylococcus aureus —"staph" for short. But, HS is different from true staph infections that cause unrelated conditions such as carbuncles , furuncles, folliculitis, boils, and staph infections of skin glands blocked by acne . Pilonidal cysts may be seen with HS, but may also occur alone.

Causes

Hidradenitis suppurativa is caused when a duct (a channel that carries gland or organ secretions) in the body is blocked. Material traveling in the duct becomes backed up and infected. The sweat and oil glands located in areas where skin folds over on itself, such as the armpits and groin, can become plugged. When this happens, oil, sweat, and dead skin cells build up. Skin bacteria may invade and produce an infection.

Risk Factors

The following factors increase your chance of developing hidradenitis suppurativa. If you have any of these risk factors, tell your doctor:

• Genetics: Although there is little that can be done to treat a genetic disease, it is important to know that this is a major part of the problem. Doctors are still determining what the genetic defect might be.
• Obesity alone or with polycystic ovarian syndrome (PCOS) , insulin resistance, or syndrome X
• Androgen dysfunction (excess male hormone)
• Crohn’s disease and some other inflammatory autoimmune conditions
• Acne and a scalp condition called dissecting cellulitis of the scalp
• Medications (eg, lithium)
• Smoking : interferes with healing, making lesions resistant to therapy

Symptoms

If you experience these symptoms, see your physician soon, before the condition progresses. Symptoms include:

• Painful swellings in the armpits, groin, under the breasts, around the nipples, or around the anus
• Pus leaking from openings in the swellings
• Foul smell from the affected areas
• Scarring
• Depression and social isolation may also occur.

If you experience any of these symptoms, do not assume it is due to hidradenitis suppurativa. These symptoms may be caused by other, more or less serious health conditions. If you experience any one of them, see your doctor.

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. This exam should include every crease and fold on your body that might be affected by HS. Tell the doctor about every lump you have. Some are not visible, but you will know where they are.

Your doctor may refer you to a dermatologist. If the disease is extensive, you may need to see other specialists. If this is the case, find a surgeon with experience in treating abscesses and sinuses.

Tests may include:

• Culture of the drainage to identify the bacteria

Treatment

Talk with your doctor about the best treatment plan for you. There are various treatment options. Some are more effective than others.

Prevention

To help reduce your chances of getting more lesions, take the following steps:

• Don't smoke. If you smoke, quit. Nicotine patches or gum will not block healing the way inhaled smoke can.
• Achieve and maintain a normal body weight.
• There is a possibility that the hormones in milk and other dairy foods may worsen HS, so consider avoiding dairy products. If you also have acne, not consuming dairy products might improve that condition as well.