Hidradenitis suppurativa: Causes, Symptoms, Treatment and Cost

An inflammatory skin ailment called hidradenitis suppurativa (HS) often affects body parts where the skin rubs against itself, such as the armpits, groyne, and inner thighs. It usually starts as small pimples or boil-like lumps. These lumps are often painful and can produce a foul smell.

The following are some of the various types of HS that have been identified:

• Verminous (involving parasites): In this type of HS, the lumps or abscesses are caused by infestation with parasitic worms or eggs.
• Acneiform (resembling acne): Acneiform HS is caused by an increase in sebum production, an oily secretion produced by glands found in hair follicles, which can lead to clogged sweat glands that become inflamed and infected with bacteria and pus-filled lumps or cysts called comedones.
• Primary axillary (armpit): In this type of HS, lesions occur primarily in the area around the armpits. These lesions often appear as small bumps filled with pus but can also appear as large patches of redness or rash around the affected area. Recurrent progressive: This kind is characterised by frequent recurrences, meaning flare-ups that continue to get worse over time if left untreated or not managed properly with treatment.
• Juvenile: This kind is usually seen in teens and young adults under age 30; symptoms may include yellowish nodules surrounded by a halo of pinkish-purple skin discolouration, itching, pain, rupture, formation, foul-smelling discharge coming out if ruptured.

The exact cause of hidradenitis suppurativa is unknown, but several factors have been linked to the development of the condition such as hormones, immune system problems, smoking, genetics and bacterial infection.
Hormones play a major role because abscesses usually occur in areas with high concentrations of hormone receptors; smokers often report higher instances of this condition than non-smokers; family inheritance may also increase susceptibility to the disease; certain types of bacteria are associated with increased risk for HS; and underlying issues with the immune system may be involved in some cases.

• Recurring, painful cysts and abscesses in the armpits, groyne or other areas affected by sweat glands.
Excess fluid drainage from these swelling areas.
• Open sores that may leak pus or release a foul smell.
• Areas of thickened skin may form with pitted scars after healing has occurred.
• Red raised bumps or boils may form around affected areas that itch and cause discomfort during movement of the area they lie in or in contact with clothing or jewellery.
• • Recurring, painful cysts and abscesses in the armpits, groyne or other areas affected by sweat glands.
  • Excess fluid drainage from these swelling areas.
  • Open sores that may leak pus or release a foul smell.
  • Areas of thickened skin may form with pitted scars after healing has occurred.
  • Red raised bumps or boils may form around affected areas that itch and cause discomfort during movement of the area they lie in or in contact with clothing or jewellery.

• Keep skin dry: Avoid tight clothing, as it can retain moisture; change clothes when wet and dry off with a clean towel after a shower/exercise.
• Minimise friction: Avoid wearing tight clothing and accessories; avoid skin irritating materials like wool or synthetic fabrics.
• Avoid certain activities: Don't shave, pick or squeeze the spots; this can worsen the symptoms and increase risk of scarring or infections.
• Exercise regularly: Exercise helps to flush out toxins from the body and regulate hormones, which can reduce uncomfortable symptoms of HS.
• Stop smoking: Smoking reduces blood flow in the body which may postpone the healing process of HS lesions and create new ones elsewhere on the body as well as other health problems associated with smoking such as cancer etc.

Hidradenitis suppurativa’s diagnosis and tests may include:

• Physical examination: During the physical exam, a doctor may look for red or purple lumps or bumps in the skin, particularly in areas prone to sweating such as the groyne, underarms, and breasts.
• X-ray: X-ray imaging is commonly used to diagnose hidradenitis suppurativa (HS). X-ray images can show how far the inflammatory process has spread, as well as any calcifications that may be present. These calcifications are areas of dead tissue that accumulate due to a heavy bacterial load in the area.
• CT scan: CT scan (also known as a CAT scan) is a type of imaging test that uses computer-processed X-rays to create detailed, cross-sectional images of the body to help diagnose conditions such as hidradenitis suppurativa. It can provide detailed 3D images of internal organs, bones, soft tissue and blood vessels.
• Laboratory tests: These may be done to rule out other conditions with similar symptoms. For example, lab tests may be used to check for Coagulase-negative Staphylococcus and/or protease-producing bacteria that are known to cause HS.
• Biopsy: During this procedure, a sample of skin or other affected tissue is removed and sent for histopathological examination. This examination can then help identify the underlying cause of the condition and allow for more informed decision-making regarding diagnosis and management.

• Infection: Hidradenitis suppurativa can potentially cause serious, sometimes life-threatening infections due to the open wounds.
• Scarring: Repeated episodes of scarring tissue formation can lead to widespread scarring and skin thickening over affected areas.
• Weakened immunity: Experiencing prolonged, severe hidradenitis suppurativa could weaken a person’s immune system, making them prone to recurring bacterial infections.
• Squamous cell carcinoma (SCC): This is an aggressive form of skin cancer that can be caused by long-term inflammation in hidradenitis suppurativa lesions.
• Lymphedema: The swelling due to disruption or removal of lymphatic channels used in surgical treatment for hidradenitis suppurativa may result in lymphedema of the legs or arms.

Applying a warm compress with castor oil can help reduce the swelling and discomfort caused by hidradenitis suppurativa.

Turmeric powder mixed with honey or yoghurt helps reduce inflammation and provides relief from itching.

Intake of neem tea, turmeric milk, or brahmi tea helps boost immunity and provide relief from inflammation caused by hidradenitis suppurativa.

Drinking aloe vera juice, amla juice and bitter gourd juice reduces the risk of infections, and reduces skin irritation and swelling associated with hidradenitis suppurativa.

Adding ginger to food helps reduce pain associated with hidradenitis suppurativa as well as anti-inflammatory properties which help in the healing of wounds from hidradenitis suppurativa lesions.

The following are some of the best foods to eat to help manage HS symptoms: Vegetables:

• Vegetables include important vitamins, minerals, and fibre that support a healthy digestive system.
• Fruits: Fruits are an excellent source of nutrients, including antioxidants and dietary fibre (which helps fill you up without added calories).Additionally, fruits contain water which can help keep you hydrated.
• Lean proteins: Consuming lean proteins, such as those found in chicken, fish, eggs, beans, and lentils, may aid in muscle growth and blood sugar regulation.
• Whole grains: Whole grains provide carbohydrates that break down into energy over time so your body doesn’t experience sudden spikes in blood sugar levels. Examples include oats, brown rice and quinoa.
• Healthy fats: Olive oil, almonds, seeds, avocados, and other foods strong in healthy fats may help lessen inflammation brought on by HS symptoms.

• Fried, greasy or processed foods: These foods contain a lot of unhealthy fats which can increase inflammation and worsen symptoms of HS.
• Dairy: Dairy products, like whole milk and cheese, are high in saturated fat and may worsen inflammation associated with HS.
• Refined carbohydrates: White rice, white bread, and pastries may all lead to blood sugar increases that exacerbate inflammation.
• Alcohol & Caffeine: Caffeine and alcohol can cause the body to experience stress, which may exacerbate the symptoms of HS. Alcohol is a recognised diuretic, meaning it causes you to lose more water than you take in.
• Spicy food: Spicy foods may increase inflammation and irritation of the skin, making it worse for those who have HS.

• Medications: Medications can play an important role in treating hidradenitis suppurativa by helping to reduce inflammation, relieve pain, and eliminate infection from the affected areas.
• Lifestyle changes: Lifestyle changes for hidradenitis suppurativa can include maintaining healthy weight, quitting smoking, avoiding tight fitting clothing and mixed fabrics, managing stress and reducing friction in the affected area.
• Excision and primary closure: a procedure to physically remove the affected area, followed by surgical closure of the wound to aid healing.
• Lancing, with or without curettage: Performed to aid drainage of abscesses and boils, with or without removing surrounding tissue and cauterising it.
• Liposuction: An extraction of excess fatty tissue from within the nodules caused by HS to reduce inflammation.
• Wide local excision and skin grafting: Excising wide areas of affected tissue, then using skin grafts to fill in any gaps where needed.
• Laser treatments and other forms of energy-based therapies : Reduces swelling, inflammation and scarring by delivering thermal energy directly onto affected areas, via different kinds of energy sources (e.g., lasers).

• A dermatologist is the best specialist to consult for Hidradenitis suppurativa, as they are experts in treating skin issues.
• It is important to see a qualified doctor as the correct diagnosis can make all the difference in treatment success.

• Antibiotics: For severe cystic lesions, topical antibiotics such as clindamycin or erythromycin may be prescribed. Systemic antibiotics – medications that are taken by mouth – may also be used to treat bacterial infection due to hidradenitis suppurativa. Antibiotics such as tetracycline, minocycline, and doxycycline are commonly prescribed for this condition.
• Retinoids: These drugs, which are derivatives of vitamin A, can help reduce inflammation and decrease the formation of acne-like lesions associated with hidradenitis suppurativa. Hormonal therapies: For women with HS in the genital area, hormonal treatments such as oral contraceptives or drugs that block male hormone production can help reduce inflammation and relieve symptoms. For men with severe prostate involvement, drugs to block testosterone production may also be used.
• Biologics: Biologics are proteins derived from living cells, including both synthetic and naturally occurring proteins, that mimic the body's natural processes and can address underlying inflammation that is thought to drive disease progression in hidradenitis suppurativa (HS).

Recovery from Hidradenitis suppurativa (HS) can vary greatly depending on severity of symptoms and individual response to treatment. Generally, symptoms will improve after several months of treatment but full recovery may take up to a year or longer.

The treatment for Hidradenitis Suppurativa can bring relief from the symptoms, and help to reduce inflammation, but it cannot guarantee permanent results. In some cases, the symptoms may return and recur over time even after treatment. Long-term management often includes lifestyle changes and medications to help manage the condition, minimise flares and improve quality of life.

• Antibiotics: For severe cystic lesions, topical antibiotics such as clindamycin or erythromycin may be prescribed. Systemic antibiotics – medications that are taken by mouth – may also be used to treat bacterial infection due to hidradenitis suppurativa. Antibiotics such as tetracycline, minocycline, and doxycycline are commonly prescribed for this condition.
• Retinoids: These drugs, which are derivatives of vitamin A, can help reduce inflammation and decrease the formation of acne-like lesions associated with hidradenitis suppurativa. Hormonal therapies: For women with HS in the genital area, hormonal treatments such as oral contraceptives or drugs that block male hormone production can help reduce inflammation and relieve symptoms. For men with severe prostate involvement, drugs to block testosterone production may also be used.
• Biologics: Biologics are proteins derived from living cells, including both synthetic and naturally occurring proteins, that mimic the body's natural processes and can address underlying inflammation that is thought to drive disease progression in hidradenitis suppurativa (HS).

The cost of treatment for Hidradenitis suppurativa (HS) in India can vary based on the severity and complexity of the condition but generally ranges from Rs. 10,000 to Rs. 1 lakh per annum. Surgery may also be needed in more advanced cases. The cost for such procedures ranges from Rs. 70,000 to Rs 5 lakh depending upon the complexity and extent of surgery required.

• Common side effects of treatments for hidradenitis suppurativa (HS) include infection, pain, itching, rash and scarring.
• Other potential side effects of HS treatments include discolouration of the skin and changes in the way certain medications affect the body.
• Antibiotics may cause nausea, vomiting, diarrhoea and abdominal discomfort in some patients.
• Some topical, oral and intravenous medications can cause allergic reactions or irritation of the skin in some people who use them to treat HS symptoms.
• Surgical procedures such as surgery can come with risks such as reduced sensation around the site of the surgery or possible risk of developing an infection at the site of surgery.