Hidradenitis suppurativa

Hidradenitis suppurativa: Description, Causes and Risk Factors:Abbreviation: HS.Alternative Name: Acne inversa.ICD-10: L73.2.Hidradenitis suppurativaHidradenitis suppurativa is a chronic, relapsing inflammatory disease of skin, characterized by recurrent draining sinuses and abscesses, predominantly in skin folds carrying terminal hairs and apocrine glands. The incidence may be as high as one in 300.The exact etiology of hidradenitis suppurativa still remains unclear, genetic factors may play a role as a positive family history has been elicited in 26% of patients with hidradenitis suppurativa. Hidradenitis suppurativa develops when the oil (sebaceous) glands and hair follicle openings become blocked with fluid, dead skin cells and other matter released from surrounding apocrine sweat glands. When these substances mix with the oil from the sebaceous glands, they can become trapped and push into surrounding tissue. Bacteria can then trigger infection and inflammation.It's not known why this blockage occurs, but a number of factors — including hormones, genetics, cigarette smoking and excess weight — may all play a role. The role of endocrine factors in the etiology of hidradenitis suppurativa has been controversial.There is no consensus about the relationship between hidradenitis suppurativa and sex, race, and site of the lesions. Axillary location seems to be more frequent in women. The gluteal, inguinal, perineal, and perianal zones are more frequently involved in men.In women, the condition frequently flares premenstrually and following pregnancy and it sometimes eases during pregnancy and after the menopause; these observations incriminate sex hormones.Hidradenitis can be aggravated through stress, heat, sweating or friction. Approximately 50% of female patients report a disease flare before or during menstruation. Smoking may be a further trigger for the disease. Hidradenitis could be also linked to the bowel disease called Crohn's disease especially if it involves the groins and the anus areas. There may be a link with acne and occasionally pilonidal sinus (a chronic abscess at the base of the spine).Symptoms:Hidradenitis suppurativa is usually painful, and the lumps hurt if they arepressed. When severe it can have psychological effects or can be associatedwith inflammation of the joints (arthritis).In the affected areas, the skin shows a variable mixture of blackheads, redlumps looking like boils, pus spots, cysts, and areas that constantly leak pus(sinuses). As time goes by, more and more scarring appears.If you have any of these symptoms do not assume it is due to HS. These symptoms may be caused by other conditions too. Tell your PCP if you have any of these.Painful swellings in the armpits, groin, under the breasts, around the nipples, or around the anus. Diagnosis:Your doctor will ask about your symptoms and medical history, and perform a physical exam. The exam will include every crease and fold on your body that might be affected. Tell the doctor about every lump, even those that are not visible.If pus or drainage is present, your doctor may send a sample of the fluid to a laboratory for testing. This test is known as a culture. Such tests may be necessary to rule out other differential diagnosis.Treatment:The long-term management of HS patients is a particular challenge. No universally effective treatment for this disease is available.Treatment options include systemic tetracyclines or macrolide antibiotics in doses similar to those given for acne. The response to treatment needs to be monitored, for which a simple lesion-count estimated by the patient is a useful measure. An alternative is treatment with an antiandrogenic hormonal preparation may be useful. Occasionally, the combination of this with an antibiotic may be beneficial. One of the most effective medical treatments for HS is unfortunately hazardous for the majority of HS sufferers due to its teratogenicity. Acitretin has been shown to lead to sometimes dramatic responses in a number of patients, but it cannot be prescribed to many of the young female HS sufferers who make up the largest group among patients.When medical treatments fail, surgery remains the only alternative. However, there appears to be a right way and a wrong way of performing surgery for HS. If your condition is severe, then a wide area may need to be removed. In these cases, a skin graft may be needed.To help reduce your chances of getting HS, take the following steps:If you smoke, quit.
  • Maintain a healthy weight.
  • Talk to your doctor about avoiding dairy products. Hormones in dairy products may worsen HS.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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