Hidradenitis suppurativa: what you need to know!

by TM Maria Be a king in your own kingdom

Hidradenitis suppurativa (HS) is a chronic disease characterized by the recurrent appearance of nodules, abscesses, fistulas and/or scars in the anatomical areas where there are apocrine sweat glands, that is, the armpits, the submammary and intermammary zones, the English and external genitals, buttocks and perianal area.

The disease is known by other names such as hidradenitis suppurativa, Verneuil's disease, apocrinitis or reverse acne.

What are your symptoms?

It usually begins with the formation of hard, painful nodules in the armpits and groin (more frequently, although it can be started in any location). These lesions can resolve spontaneously within 7-10 days, without leaving a scar. These injuries are widely known as "swallows."

In some patients, the inflammation of the nodules progresses, and an abscess forms, which is an erythematous, more painful lesion, and which can drain purulent material spontaneously or after manipulation.

There may be a single lesion, several in the same location, or in multiple locations. When there are several lesions in one location, the lesions tend to converge and even to form fistulas between them (connecting bridges inside the skin), tend to ooze spontaneously and have no tendency to spontaneous healing.

When one or several abscesses, or fistulas, are formed, they usually heal leaving a scar.

In the same patient there may be lesions in different stages of evolution, in different locations. There may be times when the disease is very active, alternating with phases of inactivity. In this way, the periodicity of the outbreaks is very variable in each patient, and the triggers of the same are not known. It is for this reason that the disease is considered chronic.

In some women, the outbreaks coincide with menstruation. Outbreaks have also been linked to friction (for example, in patients with obesity after exercise) and hyperglycemic diets.

What is its prevalence?

According to international studies, the prevalence of HS is estimated to vary from 1 to 4% of the population, according to the different studies. The real prevalence seems underestimated since many patients do not consult for the disease or they are not properly diagnosed. 

It is 3 to 4 times more frequent in women than in men.

The disease usually begins early after adolescence, although there are exceptional cases in prepubertal patients.

The disease is more active during the third and fourth decades of life, and it seems that its severity decreases with age, being exceptional in elderly patients.

What is its cause?

The cause of HS is unknown. The primary event in HS is the plugging of the skin at the hair / hair outlet (follicular canal). Within the skin, associated with the follicular canal are the sebaceous glands and the sweat glands. The occlusion of the follicular canal conditions a rupture of the same and the extrusion of its contents, including the skin cells, living bacteria associated with the follicle, sebum, and hair follicles in the surrounding tissue, and the inflammatory response characteristic of the HS, which leads to the formation of nodules and abscesses, which affect all structures associated with the follicle.

Parallel to this event, in patients with HS, the immune response that occurs in response to follicular rupture and occlusion seems altered, so that an inappropriate release of molecules cascade occurs, which leads to an exaggerated inflammatory response.

The colonization of lesions by bacteria such as Staphylococcus aureus is not uncommon. These are postulated as a secondary event in the pathogenesis of the disease and the leading role of the same in the etiology of the disease has been ruled out.

Thus, each time we know and get closer to the true origin of the HS. Initially it was postulated that it was an infection; subsequently a disease of the apocrine sweat gland; in the last decade the occlusion of the hair follicle took center stage. Recently, it is advocated to focus the disease on this inappropriate inflammatory response to follicular occlusion, and is included within the autoinflammatory diseases, that is, patients with HS produce exaggerated inflammatory responses to common events.

When to go to the doctor?

It is appropriate to see your doctor if you suffer from the symptoms described to establish the proper diagnosis.

If the patient experiences outbreaks, follow-up must be carried out according to the severity, extension and periodicity of the same.

It is always advisable to consult if a nodule appears, and it is essential if abscesses appear, since these can evolve to scars or fistulas that are difficult to treat. Abscess drainage should be performed under medical supervision, which can be performed either in the doctor's office, in the dermatologist's office or in the emergency department.

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Created on Oct 10th 2018 12:47. Viewed 296 times.

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