Hidradenitis Suppurativa – Diagnosis, Symptoms and Treatment

Hidradenitis Suppurativa - symptoms and treatment

Hidradenitis suppurativa, also known as Acne Inversa, is a chronic inflammatory skin disease that affects hair follicles, most often in areas with apocrine sweat glands. The disease is characterized by the formation of painful subcutaneous lumps, which can develop into abscesses, open with discharge of pus with an unpleasant odor, and lead to chronic recurrences, fistulas (tunnels under the skin), and scars.

This is a disease that has a significant impact on quality of life - both physically and emotionally - and often remains underestimated and diagnosed late.

Localization

Hidradenitis suppurativa most commonly affects areas with skin friction and the presence of sweat glands:

• Armpits
• Groin
• Buttock area
• Perianal zone
• Under the breasts (inframammary fold)
• Inner thighs
• Back of the neck
• Scalp (less commonly)

Symptoms that signal the patient should seek specialist consultation:

• Comedones (blackheads) - appear in small, raised areas of skin, often in pairs.
• Painful lumps the size of a pea - the condition usually begins with a single, painful lump under the skin that can persist for weeks or months. Later, additional bumps may form, usually in areas with more sweat and sebaceous glands.
• Draining bumps or wounds - some bumps enlarge, open, and discharge pus with an unpleasant odor.
• Tunnels under the skin - over time, fistulas may form connecting the lesions. These wounds heal slowly and can remain chronically active.

• Healing with scars - over time, the skin becomes thickened, with hyperpigmentation and fibrosed areas.
• Itching, burning, or feeling of tightness - in the affected areas.

Hidradenitis suppurativa usually begins after puberty and can progress for years, worsening over time. Women are three times more likely to develop the disease compared to men. Genetic predisposition is also significant - in some ethnic groups, the risk of developing the disease is higher.

When to seek medical help?

Be sure to seek medical help if you experience any of the symptoms listed below. In such cases, the patient should consult a dermatologist or surgeon, as this is a skin disease. Assessment by a surgeon is necessary to determine the treatment plan.

• Severe pain or swelling in the affected area
• Fever or chills, indicating possible infection
• Rapidly spreading redness or warmth around the lumps
• Persistent discharge of pus or blood

Causes and predisposing factors for Hidradenitis Suppurativa

The exact cause is not fully understood, but the disease is associated with blockage of hair follicles, inflammation, and bacterial infection. Main risk factors include:

Genetic predisposition / autoimmune causes,

• Obesity and metabolic syndrome,
• Smoking,
• Hormonal changes,
• Skin friction (clothing, shaving),
• Autoimmune processes.
• Lifestyle and dietary factors

Diagnosis

Diagnosis is clinical, based on characteristic symptoms and the recurrent course. Imaging studies (e.g., soft tissue ultrasound) and microbiology (in the presence of abscesses) can be helpful in some cases. Biopsy is not mandatory unless another disease is suspected.

Treatment of hidradenitis suppurativa

Therapy depends on the severity of the disease and the frequency of recurrences:

1. Medication treatment

• Topical and systemic antibiotics (clindamycin, rifampicin, tetracyclines),
• Retinoids (isotretinoin),
• Biological therapies (adalimumab, infliximab),
• Corticosteroids and anti-inflammatory agents.

1. Surgical treatment

After being diagnosed with Hidradenitis Suppurativa, many patients face the question: is surgical treatment necessary and when should it be applied?

Surgery can be applied at all stages of the disease, depending on the severity and extent of the lesions. In many cases, medication treatment is started first to control inflammatory activity, after which surgical intervention is undertaken to achieve long-term remission. Sometimes, however, especially with limited, single lesions, surgery can be performed at early stages - with the aim of their complete removal and prevention of recurrences.

It is important to emphasize that when there are indications for surgical treatment, it should not be delayed, as delay can lead to expansion of the inflammatory process, formation of fistulas, and permanent skin damage.

Main surgical approaches:

• Drainage of abscesses,
• Radical excision of chronic lesions - with the aim of permanently removing affected tissue; if needed, skin transplantation can be applied to restore the area.

1. Other therapeutic approaches

• Laser therapy and photodynamic treatment,
• Weight control and smoking cessation,
• Use of antiseptic cleansing products and warm compresses,
• Psychological support when needed.

Lifestyle advice and recommendations

Although there is no guaranteed method for preventing the disease, the following measures can reduce the risk of flare-ups:

• Maintaining good hygiene with antiseptic products,
• Wear cotton clothing, avoid tight clothes and mechanical friction,
• Maintain a healthy weight,
• Limiting smoking and dairy products (if they lead to flare-ups).
• Avoid antiperspirants with aggressive chemicals and do not apply moisturizers to affected areas.

Hidradenitis suppurativa is a chronic and socially significant disease that significantly worsens quality of life. Timely diagnosis and proper treatment can limit complications and improve the patient's condition. If you suspect you have hidradenitis suppurativa or experience symptoms, it is important to consult a medical specialist for an accurate diagnosis and appropriate treatment.

The information is provided for educational purposes and does not replace consultation with a medical specialist. If you suspect a disease, always consult a qualified healthcare professional for any medical problems or before making any decisions related to your health.