Hidradenitis Suppurativa: Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Complications

Acne inversa, sometimes referred to as hidradenitis suppurativa, is characterised by tiny, painful bumps under the skin. The armpits, groyne, buttocks, and breasts are the parts of your body where skin rubs against one another and is most prone to develop bumps. The lumps may return, heal slowly, and leave behind scars and skin behind tunnels.

Before turning forty, but frequently after adolescence, hydradenitis suppurativa manifests itself. It may continue for some time and get worse with time. Your everyday activities and mental health may be impacted. Medication and surgery together can help control the condition and avoid problems.

Hydradenitis suppurativa is three times more common in women, although the exact ratio varies according to the location. It's possible that a hereditary component could be a reason for this.

Some patients with this condition only have minor symptoms. It's unknown how the disease will progress. While being overweight and a smoker is linked to more severe symptoms, being skinny and not smoking might still result in a catastrophic illness.

Causes Of Hidradenitis Suppurativa

The cause of hair follicle blockage, which results in hidradenitis suppurativa, is unknown. Experts surmise that factors such as hormones, genetic predisposition, cigarette smoking, or obesity might be at play.

It is not infectious or the result of disease or dirty hands that causes hidradenitis suppurativa.

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Symptoms Of Hidradenitis Suppurativa

The symptoms of hidradenitis suppurativa might affect one or more body areas. The following are the signs and symptoms of the illness:

• Blackheads: Blackheads are small, pitted spots of skin that usually appear in pairs.
• Painful lumps the size of peas: A single uncomfortable lump under the skin that lasts for several weeks or months is usually the first sign of the sickness. Later on, more pimples could show up; they are usually found where the skin scrapes against one another or where there are more sweat and oil glands, such as the armpits, groyne, buttocks, and breasts.
• Leaking lumps or sores: Some lesions or tumours swell, burst, and exude foul-smelling pus.
• Tunnels: Eventually, tunnels beneath the skin may grow to join the lumps. These cuts release pus and blood, and they heal slowly, if at all.

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Risk Factors Of Hidradenitis Suppurativa

The subsequent factors increase the likelihood of developing hidradenitis suppurativa:

• Age: The age groups of teenagers and twentysomethings are particularly vulnerable to hidradenitis suppurativa.
• Sex: Women are more likely than men to develop hidradenitis suppurativa.
• Race: The risk level may vary depending on race or ethnicity. Black people have an increased risk of developing the condition, possibly due to hereditary factors.
• History within the household: A disorder known as hidradenitis suppurativa may run in families.
• Particular conditions: Overweight individuals have an increased risk of having severe cases of hidradenitis suppurativa. Severe acne, diabetes, metabolic syndrome, and inflammatory bowel disease are also linked to it.
• Smoking: Tobacco consumption and hidradenitis suppurativa are related.

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Diagnosis  Of Hidradenitis Suppurativa

There are situations when hidradenitis suppurativa can be mistaken for acne or pimples. For many people, receiving an accurate diagnosis can take years.

The diagnosis made by your healthcare provider will take into account your symptoms, medical history, and skin appearance. You can be sent to a dermatologist or a doctor who specialises in skin conditions. Diagnosinghidradenitis suppurativa can be difficult and requires specialised management.

A laboratory test to diagnose hidradenitis suppurativa does not exist. If there is pus or leakage, though, your medical expert might take a sample for laboratory examination.

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Treatment  Of Hidradenitis Suppurativa

To help control symptoms and prevent complications, hydradenitis suppurativa can be treated with medication, surgery, or a combination of the two. Talk to your doctor about the benefits and drawbacks of the several treatment options available to you, as well as how to design a personalised strategy.

Make regular follow-up appointments with your dermatologist. Some patients may need a multispecialty healthcare team to receive comprehensive care.

Medications

Your doctor may prescribe one or more of the following categories of medications:

• Antibiotics: An antibiotic applied topically as a gel or liquid may be used for mild symptoms. This family of pharmaceuticals is known as topical antibiotics. For a more widespread disease, your doctor might prescribe several antibiotics, such as clindamycin, Rimactane, Cleocin, Doxycycline, or more than one of these drugs. Rifampicin is another term for rifampin. Patients with severe infections may need to take antibiotics for several months.
• Injections of steroids: Triamcinolone acetonide, often marketed as Kenalog-10, can be injected into the sores to reduce inflammation and swelling.
• Hormone therapy: Hormone tablets, such as estrogen-containing combined oral contraceptives like estradiol and estradiol/norgestimate, may be beneficial for people with mild cases of hidradenitis suppurativa. Spironolactone is often used to reduce the need for antibiotics and isotretinoin, a drug mostly used to treat acne. 
• Biologic products: In a matter of weeks, these injectable drugs break the cycle of sickness and relieve symptoms and signs of illness by altering the immune system. Several of these drugs are approved for the treatment of mild to severe hidradenitis suppurativa. Two examples of TNF inhibitors include adalimumab, often marketed as Humira, and infliximab, marketed as Remicade.
• Tumour necrosis factor is a component of the immune system that these medications suppress. Clinical trials are underway for numerous different biologics for hidradenitis suppurativa.
• Retinoids: For certain individuals with a condition resembling acne, oral retinoids may be an option. It is not advised to use these medications if you are nursing a baby, wish to get pregnant, or are currently pregnant.
• Pain medicine: Your doctor may prescribe a stronger pain medication or refer you to a pain clinic if over-the-counter pain medicines are ineffective.

Operations like surgery

Hydrogenadenitis suppurativa can be treated with a combination of surgical and pharmaceutical approaches. Surgery is an essential part of the treatment plan when a tunnel, lump, or abscess is present. The optimal kind of surgery for you will depend on how serious and pervasive your sickness is. Talk to your healthcare provider about the benefits and drawbacks of each option, including:

• Uncovering the tunnels: During this operation, tissue must be removed to disclose the tunnels beneath the skin. This is also known as unroofing. Patients with mild to severe forms of hidradenitis suppurativa are treated with it. This method usually doesn't need to be repeated.
• Punch debridement: This procedure involves removing a single inflammatory lump and is also referred to as confined unroofing.
• Laser therapy: One effective therapeutic option for lesions caused by hidradenitis suppurativa is hydrogen dioxide laser therapy. After this treatment, it is unlikely that the sores will return. Laser hair removal may be beneficial in the early stages of treatment for hidradenitis suppurativa.
• Surgical removal: Those with serious or persistent issues might benefit from this approach. It means shaving off any skin that is affected. To close the wound, a skin graft can be necessary. Even after surgery, sores may still appear in other areas.
• Cutting and clearing out: It is no longer believed to be helpful to treat hidradenitis suppurativa with surgical drainage. Even though the process can be perceived as providing temporary
• Pain relief, sores typically reopen later.

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Complications  Of Hidradenitis Suppurativa

The following are possible consequences of severe and protracted hidradenitis suppurativa:

• Infection: Secondary infection may occur in the affected area, but pus is common in hidradenitis suppurativa and may not always signify infection.
• Changes in skin and scars: The wounds may continue to heal with rope-like scars or pitted skin.
• Restricted range of motion: Sores and scar tissue can cause discomfort or limit movement, especially if the problem affects the armpits or thighs.
• Carcinoma of the skin: Squamous cell carcinoma has been associated with long-term hidradenitis suppurativa, particularly in patients whose disease involves the perianal region. This area is made up of the tissues around the anus.
• Swelling in the arms, legs, or genitalia: The regions with the highest prevalence of hidradenitis suppurativa also contain a large number of lymph nodes. Scar tissue can interfere with the lymphatic drainage system, leading to genital, arm, or leg oedema.
• Psychological effects and social isolation: The location, drainage, and odour of the sores can cause anxiety or depression, making patients feel ashamed and afraid to go out in public.
• Pain that lasts a lifetime: This pain is far worse than psoriasis and other disorders combined.

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