Hidradenitis Suppurativa

Key Points
Chronic Inflammation of the skin that affects the apocrine glands (sweat glands in certain parts of the body)
Affects underarms, groin area, buttocks, and inner thighs
May cause scarring
Often misdiagnosed as “recurrent staph infections” by primary care physicians, and although secondary staph infections may occur and even be cultured, the infection is not the primary problem

Hidradenitis suppurativa is somewhat similar in appearance to acne. It affects the apocrine glands, which are sweat glands in certain parts of the body, like the underarms, the inner thighs, breasts (in women), and the groin area. Hidradenitis suppurativa is characterized by large cyst-like bumps caused by blockage of the apocrine glands — the bumps can be as small as a pea or as big as a golf ball. The bumps are extremely painful to the touch. Hidradenitis suppurativa may last for years, with occasional to frequent inflammation culminating eventually in the drainage of pus, which leaves wounds that often will not heal. While drainage can relieve some of the pain, flare-ups can be caused by stress, tight clothing, hormonal changes, sweat, or humidity. Secondary bacterial infections cause worsening pain and odor.

The condition affects females more often than men.

Differential Diagnosis (Other conditions with similar appearance)
Carbuncle
Candidiasis
Cellulitis
Erysipelas

Diagnosis
Small pitted areas of skin that contain Blackheads
Tender bumps that fill with pus
* Pea-sized lumps under the skin

Hidradinitis can begin around puberty with a single, painful bump that persists. The condition may worsen as you age and cover more areas of your body, often in a tract-like pattern. If you have more than three boils in any one year, you should check with a dermatologist, as he or she will be able to diagnose hidradinitis. As many as 80 percent of hidradinitis patients also suffer from depression, which is common to those experiencing persistent pain. It is important to address the cause of the underlying depression as well.

Treatment
There is no cure for hidradenitis suppurativa. However, it can often be managed — mild cases through self care, and more severe cases with medications or surgery. Oral and topical Antibiotics are the first line of defense; anti-inflammatory medications can be added to the arsenal. Birth control pills can help with women. In more severe cases, surgery to remove the lesions is necessary and, in some cases, skin grafts or plastic surgery may be needed.

Lifestyle changes are also important. While obesity does not cause hidradinitis, it does exacerbate it. Smoking also can worsen the disorder. Tight-fitting clothing should be avoided, and shaving around the affected areas is strongly discouraged. The affected areas should also be cleaned daily with anti-bacterial soap. Warm compresses or icing the inflamed areas may also help. Try to avoid stress.