Hidradenitis Suppurativa - Western SummaryWestern Medicine Summary

Western Medicine

Western Summary

Hidradenitis suppurativa (HS) is also called acne inversa. 

Symptoms

It is a chronic skin disease that affects the skin folds, such as armpits, below the breasts, abdominal folds, groin and buttocks. In HS, the hair follicles and apocrine glands (a type of gland that connects to the hair follicles) are plugged by keratin that make up the outer layer of the skin and hair follicles, forming blackheads and whiteheads. The blocked hair follicles then rupture and become inflamed, forming clusters, painful boils and cysts. The boils and cysts break open and drain foul-smelling fluid. The open skin can be slow to heal and form significant scarring. In severe cases, clusters of boil and cysts can connect with each other beneath the skin and form tunnels called sinus tracts. The affected skin is frequently infected with bacteria and fungus, making the skin even more difficult to heal. HS can be seen in men and women but typically do not appear until puberty. 

 

Causes

The exact cause of HS is not yet understood, but several factors are linked to its development:

  • Overweight and obesity
  • Smoking
  • Acne
  • Diabetes
  • Inflammatory bowel diseases (Crohn’s disease and ulcerative colitis)
  • Pyoderma gangrenosum
  • Hormonal abnormalities
  • The immune system responds abnormally to bacteria and fungi that normally live on the skin

Treatments

  • Anti-septic washes such as chlorhexidine and benzoyl peroxide, or bleach baths
  • Topical or oral antibiotics for bacterial infections
  • Topical oral antibiotics can reduce skin inflammation 
  • Birth control pills or medications that blockstestosterone function (such as spironolactone and finasteride) can help normalize the hormonal imbalance linked to HS
  • Metformin help can influence insulin resistance and diabetes associated with HS
  • Oral retinoids (such as acitretin, isotretinoin) can decrease hair follicle plugging and inflammation
  • Tumor necrosis factor injections such as adalimumab and infliximab
  • Incision and drainage of the boils and abscesses
  • Intralesional injection of steroids directly into the boils and inflamed cysts
  • Laser hair reduction
  • Excision of the affected areas
  • Incision and drainage of the boils and abscesses
  • Intralesional injection of steroids directly into the boils and inflamed cysts
  • Laser hair reduction
  • Excision of the affected areas<