Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic medical condition of the skin characterized by pea-sized to marble-sized deep-seated bumps beneath the skin. Hidradenitis suppurativa is a rare condition and affects an extremely minor percentage of people. The bumps commonly develop in the regions where the skin rubs together, such as the armpits, under the breasts, groin area,between the buttocks and inner thighs.They are often painful and can rupture and start draining foul-smelling pus. In many patients, there is formation of tunnels which connect different bumps under the skin.
Hidradenitis Suppurativa (HS) or Acne Inversa usually starts after puberty and they are present for many years and can worsen over the time. It’s important to diagnose and start treatment early, so that the symptoms can be managed and formation of new bumps can be prevented.
Causes of Hidradenitis Suppurativa (HS) or Acne Inversa
The cause of Hidradenitis Suppurativa (HS) or Acne Inversa is blockage and inflammation of hair follicles leading to formation of painful lump under the skin. The exact cause of this blockage is not known. Some of the probable causative factors include genetics, hormones, smoking and being overweight.
Risk Factors for Hidradenitis Suppurativa (HS) or Acne Inversa
- Women are at an increased risk for developing hidradenitis suppurativa than men.
- Individuals with family history of hidradenitis suppurativa are more likely to develop this condition.
- Young adults are more prone to develop it.
Signs and Symptoms of Hidradenitis Suppurativa (HS) or Acne Inversa
- Patient develops small dented areas of skin,which have blackheads in them. These blackheads commonly develop in pairs or in a “double-barreled” fashion.
- Development of tender, red, painful bumps under the skin, which can grow in size then later rupture and start draining foul smelling pus.
- The hard bumps, which develop beneath the skin can persist for many years then increase in size with inflammation in them.
- There may be burning sensation, itching and excessive sweating with the bumps.
- After the bumps rupture and form open sores, they tend to heal very slowly. Even if they heal, there is often scarring present and formation of tunnels which connect these bumps under the skin.
- Symptoms worsen during summer, stress, hormonal changes or excessive perspiration.
- It’s important to consult your doctor if there is extreme pain, and the bumps do not resolve, are present in multiple locations or recur even after treatment.
Investigations for Hidradenitis Suppurativa (HS) or Acne Inversa
Physical examination is usually sufficient for diagnosis. A sample of the fluid or pus drainage can be taken and sent for testing and further confirmation of the diagnosis.
Treatment for Hidradenitis Suppurativa (HS) or Acne Inversa
As of now, there is no definite cure for hidradenitis suppurativa. Treatment helps in managing the symptoms and preventing new lumps from developing. Treatment comprises of:
Medications for Hidradenitis Suppurativa (HS) or Acne Inversa
- Topical or oral antibiotics are prescribed which help in preventing further worsening of this condition if they are taken for long term duration.
- Corticosteroids can be injected into the painful bump, which will help in decreasing the inflammation. Oral steroids can also be prescribed; however, long term use of them has serious side effects.
- TNF-a/Tumor Necrosis Factor-Alpha Inhibitors comprise of medications, such as adalimumab and infliximab,which help in alleviating the symptoms of Hidradenitis Suppurativa. The downside of these medications is they make the patient more vulnerable towards infection, heart failure and some cancers.
Surgical Procedure for Hidradenitis Suppurativa (HS) or Acne Inversa
Surgery is done for severe cases, deep lesions or persistent lesions.
- Incision and drainage (I and D): If a small region of the skin is affected, then surgical drainage helps in treating it. However, the relief from the treatment is usually of short-term.
- De-roofing is the process where the interconnected tunnels are uncovered by cutting the skin and flesh which covers them. However, there is always a chance of recurrence of this condition.
- Surgically removing the entire affected skin helps in treating recurrent lesions. Skin grafting is commonly required to close the wound. This procedure helps in treating the present Hidradenitis Suppurativa (HS) or Acne Inversa, but cannot prevent it from developing in other regions.
Home Remedies for Hidradenitis Suppurativa (HS) or Acne Inversa
- Always keep the affected region clean by gently washing it with an antibacterial soap, patting it dry and applying an OTC antibiotic.
- Application of warm compresses help in relieving pain and swelling.
- Always wear loose fitting and comfortable cotton clothes.
- If you are overweight, losing weight will help in this condition, as excess weight causes increased areas where the skin rubs together,such as between the thighs, skin folds etc. leading to increased friction, perspiration and bacterial growth.