Hidradenitis Suppurativa
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Hidradenitis suppurativa is characterized by the onset of small lumps the size of a nut under the skin. Lumps can be painful and contain pus. Hidradenitis suppurativa is also often referred to as acne inversa.
Suppurphriva hidradenitis arises in areas of the skin with hair and sweat glands, especially those that often experience friction, such as the armpits, groin, thigh folding, buttocks, and breasts. This condition tends to occur after puberty and lasts for a long period (chronic).
Untreated lumps of suppurative hidradenitis can develop and worsen over time. If it breaks, pus inside the lump will come out and infect the surrounding skin.
Causes of Hidradenitis Suppurativa
Hidradenitis suppurativa occurs when the follicles (hair roots) or sweat glands are blocked. The exact cause of the blockage is not yet known, but it is suspected to be related to the following factors:
Friction between the skin and clothing
Inflammation that causes the root wall of the hair to break, damaging the apron glands and ducts
Secondary bacterial infections, that is, infections that occur during or after the treatment of other infections
Certain medications
Please note that hidradenitis suppurativa is not associated with poor body hygiene. This condition is also not contagious, but it is more at risk of occurring in people with the following factors:
Age
Generally, suppurative hidradenitis is experienced by people who have just passed puberty, especially those aged 18–29.
Genetics
In most cases, suppurative hidradenitis occurs in people whose family members suffer from similar conditions.
Gender
Women are more often affected by hidradenitis suppurativa compared to men.
Lifestyle
Obesity and smoking habits have been shown to increase the risk of hidradenitis suppurativa
Certain diseases
Hidradenitis suppurative is more prone to occur in people suffering from certain diseases or conditions, including diabetes, psoriasis, metabolic syndrome, and Crohn's disease.
Symptoms of Hidradenitis Suppurativa
Symptoms of suppurative hidradenitis can vary from patient to patient. The severity of the symptoms can also be mild to severe. Some symptoms can occur over the years and worsen over time.
Hidradenitis suppurativa usually arises under the skin that has hair roots and sweat glands, as well as frequent friction, such as:
- Armpits
- Thigh folding
- Inner thigh
- Neck neck
- Breast folds
- Stomach folds
- Behind the ears
- The area around the rectum, precisely in the buttocks
The following are the symptoms of suppurative hidradenitis that can occur in one or several areas of the sufferer's skin:
- Acne-like bumps appear on areas of the skin that have never previously experienced acne
- Blackheads that number more than one
- An abscess-filled lump that is painful and will multiply in a matter of weeks or months
- The lump continues to develop until it finally breaks and secretes smelly pus
- A broken lump will cause a wound that is difficult to heal so that it turns into scar tissue on the skin
In severe cases, a channel (sinus) will form under the skin that connects one blister to another, resulting in more difficult healing.
When to see a doctor
Examine the doctor if a lump arises under the skin that is accompanied by the following symptoms:
- Pain
- Arises in more than one part of the body
- Doesn't get better in a few weeks
- Easily spreads to surrounding parts of the body
- Relapse after treatment for several weeks
Diagnosis Hidradenitis Suppurativa
Diagnosis of suppurative hidradenitis is made by asking about the patient's symptoms and medical history. After that, the doctor will perform a physical examination and determine the severity of hidradenitis suppurativa using the Stage Hurley scale. The following is the explanation:
Stadium 1
An abscess appears in one or another area but separates from each other without forming scar tissue and sinus ducts.
Stadium 2
An abscess appears in one or several areas, and sinus channels begin to form.
Stadium 3
An abscess appears in several areas and is connected by a sinus duct.
The doctor will perform a biopsy to examine a pus sample if the lump is accompanied by pus. That way, the type of bacteria in it can be known.
Since skin infections generally occur in diabetics, doctors can also ask the patient to undergo a blood test to determine if the patient has diabetes. Blood tests are also performed to monitor the degree of infection and inflammation.
Treatment of Hidradenitis Suppurativa
Treatment of hidradenitis suppurativa aims to relieve symptoms and prevent complications. Treatment will be adjusted to the severity of each patient's condition. The following are some of the treatment methods that can be carried out:
Medicines
The types of medications that can be prescribed by a doctor to treat supportive hidradenitis include:
Antibiotic
In mild suppurative hidradenitis, patients are usually only given smear antibiotics to relieve infections, such as clindamycin and gentamicin. However, for severe cases, the patient will be given a combination of oral antibiotics that must be taken for 2–3 months.
Antiseptic
The doctor may also advise using antiseptics containing chlorhexidine to slow down or stop the growth of bacteria. The drug is generally recommended to be used daily in diseased areas.
Painkillers
The doctor may give painkillers, such as paracetamol or ibuprofen, to relieve pain.
Retinoid
Retinoid medications commonly used to treat acne, such as isotretinoin, can also be prescribed by a doctor to help with treatment by opening clogged skin pores. However, this drug is not recommended to be taken by pregnant women.
Corticosteroids
Corticosteroid tablets, such as prednisone, can be given by a doctor to reduce pain and inflammation in the skin. However, corticosteroids are not recommended for long-term use.
Immune system suppressant drugs
Immune system suppressant drugs, such as infliximab or adalimumab, can also be used to relieve suppurative hidradenitis. However, this drug is only given if other treatments are unsuccessful.
Operation
If necessary, suppurative hidradenitis will be treated surgically. The type of surgery performed by the doctor may vary from patient to patient, depending on the severity, location, and extent of the skin area affected by this condition.
The following are some types of operations that can be used to treat hidradenitis suppurativa:
- Incision and drainage of abscesses, to slice the lumps and remove pus
- Skin removal surgery removes the skin and tissues on the lump, both on one lump and the lump that has formed sinuses.
- Skin graft surgery removes the area of the skin with hidradenitis suppurativa, then closes the wound with healthy skin taken from other body parts.
- Laser therapy to remove bumps and wounds on the skin by using a carbon dioxide laser
Hidradenitis suppurativa is usually difficult to heal and can cause lifelong relapses. However, if the treatment is carried out as early as possible, especially with surgery, the patient's chances of fully recovering without experiencing a relapse will be higher.
In rare cases, suppurative hidradenitis can also resolve independently without treatment.
Complications of Hidradenitis Suppurativa
Severe suppurative hidradenitis or persistent relapses can decrease the quality of life of the sufferer and cause some complications, such as:
- Infection around the affected area of the skin
- Scarring in the affected skin
- Pain and limited gestures (contractures), especially around the affected area
- Skin cancer
- Swollen lymph nodes in the arms, legs, or genital area
- Psychological disorders, such as depression and social isolation
- Joint pain and arthritis
- The formation of fistulas in other parts of the body, such as the intestines and bladder
Prevention of Hidradenitis Suppurativa
Hidradenitis suppurativa is a condition whose cause is not known with certainty. Therefore, no way can be done to prevent this condition from occurring. The best effort that can be made is to prevent the symptoms from getting worse, among them by:
- Keeping the weight ideal
- Wearing comfortable and loose-fitting clothes
- Bathing with warm water
- Cleaning the lump area with antibacterial soap
- Does not shave off the hair that grows on the bumps and surroundings
- Avoiding hot and humid air
- Quit
- Maintain healthy skin by diligently bathing, drinking plenty of water, not using beauty products carelessly, and regularly changing clothes
- Regular treatment and control to the doctor if you suffer from diabetes
Last updated: August 12, 2022
Reviewed by: dr. Pittara
