Makindo Medical Notes

It is a chronic inflammatory skin condition that affects apocrine gland-bearing skin in the axillae, groin, and under the breasts

About

• Consider if recurrent inguinal or axillary abscesses
• Chronic inflammation develops in the skin.
• Usually begins after puberty as pimple-like bumps.

Risks

• Affects 1-4% of the general population
• Women more than men. Acne inversa

Aetiology

• Family hx, Women, Obesity and Insulin resistance
• African origin, Crohn's disease, Psoriasis, Smoking
• Hirsutism, Acne, lithium, sirolimus, biologics

Clinical

• Develops pimples, blackheads, infected hair follicles, or boils.
• Open double headed comedones
• Can develop painful, deep, swollen lesions that can result in abscesses, which are similar to pimples.
• Can enlarge and break open with bleeding and pus.
• Severe cases scarring, disfigurement, and disability.
• Affects areas of the skin containing sweat glands.
• Armpits, Under breasts, groin, vulva, buttocks

Severity

• Stage 1: small single lesion or multiple lesions without scarring.
• Stage 2: More than one widely-separated, frequent lesions with scarring.
• Stage 3: Widespread disease with many interconnected lesions.

Management

• General advice: Decrease injury, friction, heat, and sweating to the area. Wear loose fitting clothing, cotton underwear or loose boxer style underwear. Avoid any pads. Lose weight (ask your doctor). Start a zero dairy with low glycaemic load diet (ask your doctor). Stop smoking and stop all nicotine products. If possible, get laser hair removal. Use antibacterial soap
• Identifying and treating HS early can prevent it from worsening. The goal of treatment is to slow the disease progression and to decrease the symptoms. Currently there is no cure for hidradenitis suppurativa
• Incision and drainage of abscesses
• Preventive treatments, regardless of the stage: Zinc picolinate 30 mg with copper 2 mg twice day, Vitamin C 500 mg three times day, Vitamin D3 2000-5000 IU are used daily. If appropriate oral contraceptives (Yaz or Yasmin) with the hormone drospirenone have been shown to help
• Stage 1: antibiotic ointment, oral antibiotics, or oral contraceptives (birth control) with hormones that block acne.
• Stage 2: antibiotic ointment, oral antibiotics, oral contraceptives with hormones that block acne, or steroid shot into the lesion. Surgery or targeted therapy (specific drugs used to treat the factors causing your condition) are sometimes recommended.
• Stage 3: Same medical treatments as seen in Stage 1 and Stage 2 with the addition of surgery. Your surgeon will decide which surgery fits you based on what stage you are in
• Pregnancy: Hidradenitis suppurativa tends to improve in pregnancy in those who usually have flares during menstruation. Normal vaginal delivery is possible unless the patient has extensive painful genital lesions.

References

• Hidradenitis suppurativa
• Hidradenitis suppurativa