Hidradenitis suppurativa:
It is a chronic, recurrent, debilitating disease that usually presents after puberty with painful, deep seated, inflammatory lesions in the areas of the skin where there is the presence of apocrine glands. These lesions tend to heal with severe scars and keloids, causing distortion of the anatomy in the affected area.
The recurrent abscesses form sinuses and fistulas become chronic and discharge pus every now and then.
Hidradenitis Suppurativa is insidious at onset and occurs more commonly in post-pubertal females than males. The diagnosis is made clinically and it is rarely needed to perform a biopsy or culture of the discharge material. Some differential diagnoses to be considered are furuncles, carbuncles, actinomycosis, Crohn’s disease, granuloma inguinale, lymphogranuloma venereum, pilonidal sinus, tuberculosis and ischiorectal abscess.
This disease appears more frequently in the axillae, inguinal or perianal regions. However, it is not uncommon to find small abscesses in the mammary, gluteal, pubic, upper thigh and retro-auricular regions. Basically, areas where there is abundance of apocrine sweat glands and areas where there is constant rubbing of the skin.
As the disease progresses, new abscesses appear in areas of friction and occluded areas of the skin. They usually begin as tender subcutaneous nodules, which rupture spontaneously to form painful deep dermal abscesses. These can rupture with the discharge or a serous to purulent malodorous fluid, resulting in the soiling of clothes and social embarrassment. Later, there is formation of contractures and strictures which can lead to severe scarring and restriction of certain movements. There is also a higher risk of squamous cell carcinoma formation in the affected areas. The severity of HS has been graded into three stages as seen in table 1.
Table 1
|
Hurley Stage |
Extent of disease |
|
1 |
Abscess formation (Single or Multiple) without sinus trails |
|
2 |
One or more widely separated recurrent abscesses with tract formation
and scars |
|
3 |
Multiple interconnected trails and abscesses throughout an active area |
There have been a few studies suggesting that obesity and smoking can increase the severity of this disease. In obese people, there is sweat retention between the skin folds, maceration, bacterial overgrowth as well as occlusion of the follicular or ductal outlet. Thus, weight loss can improve this disease. The use of tobacco is associated with an increased prevalence of HS and therefore lifestyle changes will benefit sufferers.
Dr R Newaj has a special interest in the treatment of HS and utilises Carbon dioxide laser to improve the lesions.
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