Hidradenitis suppurativa By – Pradeep Jaiswal Group no. 317

Definition Hidradenitis suppurativa is a skin disease that most commonly affects areas bearing apocrine sweat glands or sebaceous glands, such as the underarms, breasts, inner thighs, groin and buttocks.

Contents Overview Causes Treatments Areas of Involvement in Men and Women with Hidradenitis Suppurativa Causes Treatments

Overview The non-contagious disease manifests as clusters of chronic abscesses, epidermoid cyst, sebaceous cysts, pilonidal cyst or multilocalised infections, which can be as large as baseballs or as small as a pea, that are extremely painful to the touch and may persist for years with occasional to frequent periods of inflammation, culminating in incision and drainage of pus, often leaving open wounds that will not heal. Flare-ups may be triggered by perspiration, hormonal changes (such as monthly cycles in women)

Persistent lesions may lead to scarring and the formation of sinus tracts, or tunnels connecting the abscesses or infections under the skin. At this stage, complete healing is usually not possible, and progression varies from person to person, with some experiencing remission anywhere from months to years at a time, while others may worsen and require multiple surgeries in order to live comfortably. Wound dehiscence, a premature "bursting" open of a wound often complicates the healing process. Occurrences of bacterial infections and cellulitis (deep tissue inflammation) may occur at these sites. HS pain and depression can be difficult to manage.

Areas of involvement in men and women with hydradenitis suppurativa HS Patients (n=164, 121 females, 43 males) Female Male p (Statistical Significance) Axillae 70 (58%) 30 (70%) NS (not significant) Mammary and inter-mammary 31 (26%) 2 (5%) 0.006 Inguino-femoral 111 (92%) 32 (74%) 0.007 Perianal and Perineal 40 (33%) 24 (56%) 0.01 Buttocks 30 (25%) 21 (50%)

Hidradenitis in groin region

Causes As this disease is poorly studied, the causes are controversial and experts disagree. Hydradenitis suppurativa occurs when apocrine gland become plugged. Lesions occur in areas of the body with numerous apocrine glands such as the axilla, groin, and perianal region. This theory includes most of the following potentials indicators. females are more likely than males genetic predisposition among families.

Research is assessing possible relations with Hashimoto's Thyroiditis, Crohn's Disease, Rheumatoid Arthritis, and Squamous Cell Carcinoma. Plugged apocrine (sweat) gland or hair follicle excessive sweating bacterial infection androgen dysfunction. being overweight makes it worse. HS is not caused by any bacterial elements.

Treatments Treatments may vary depending upon presentation and severity of the disease. Lifestyle Changes in diet avoiding inflammatory foods, foods high in refined carbohydrates. Warm compresses, hydrotherapy, balneotherapy Icing the inflamed area daily until pain reduction is noticed Weight loss in overweight and obese patients.

Medication Antibiotics like Rifampicin &Clindamycin etc. Corticosteroid injections. Also known as intralesional steroids. Vitamin A supplementation Anti-androgen therapy.

Intravenous or subcutaneous infusion of anti-inflammatory drugs. Zinc gluconate taken orally has been shown to induce remission. Recommended dose is at least 30 mg taken 3 times daily (90 mg/day). Toxicity is known to occur at doses exceeding 1000 mg/day.

Chlorhexidine (Hibiclens) plus an antibiotic soap for cleansing the skin surface. Hexachlorophene shower with liquid soap like Phisohex, covering sores with Metrolotion after medicated showers. These are considered to be general measures, and are the foundation of any good medical treatment and management plans for HS. Topical clindamycin has been shown to have an effect in double-blind placebo controlled studies.

Surgical therapy When the process becomes chronic, wide surgical excision is the procedure of choice. Wound in the affected area do not heal by secondary intention, and immediate application of a split thickness skin graft is more appropriate. Radiation Electron beam radiotherapy has been a successful treatment of hidradenitis, especially in Europe; it is not a common treatment option in most of the United States, as radiation oncologists generally refuse to treat patients with non-malignant diseases because of the potential for secondary radiation-induced tumors in the long term.