Introduction to Hidradenitis Suppurativa
Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition that causes painful bumps and abscesses to form in areas where skin touches skin, like the armpits, groin, and under the breasts. This condition is long-lasting and often worsens over time. Let's take a closer look at HS symptoms, causes, diagnosis, and treatment options.
Symptoms of Hidradenitis Suppurativa
The main symptoms of HS include:
Painful Bumps and Lesions
People with HS develop painful lumps and lesions on the skin that can resemble pimples or boils. These typically occur in areas where skin rubs together like the armpits, groin, under the breasts, and butt. Lesions can be deep-seated and rupture, leaking pus and fluid.
Tunneling Scars
The chronic inflammation caused by HS leads to poor healing in the affected areas. This results in the formation of sinus tracts and scarring. Scars often interconnect, creating a tunneling effect under the skin.
Skin Discoloration
Areas impacted by HS can become discolored over time. You may notice dark spots, hyperpigmentation, or dark tunnels of scarring in the underarm or groin creases.
Pain and Discomfort
HS lesions are often extremely painful. You may experience burning, stinging, or throbbing pain. Moving areas with lesions can worsen discomfort. Pain can linger even after lesions heal.
Foul Odor
Draining tunnels and open wounds caused by HS can lead to an unpleasant odor in affected areas. The smell is often described as rotten or fishy.
Other Symptoms
Some other signs of HS include itching, swelling, fatigue, embarrassment, and depression. Symptoms can range from mild to severe.
What Causes Hidradenitis Suppurativa?
While the exact cause of HS is unknown, several contributing factors appear to be involved.
Genetics
HS often runs in families, suggesting genetics play a role. Around 30% of people with HS have at least one affected family member.
Hormones
HS is more common in women, indicating hormones may be involved. Flares are also common around the menstrual cycle. Androgens likely contribute to disease progression.
Smoking
Smoking is a major risk factor for developing HS. It is also linked to more severe symptoms. Quitting can help improve the condition.
Obesity
People who are overweight or obese have a higher risk of HS. Excess weight is linked to increased disease severity. Losing weight may help reduce symptoms.
Skin Friction
Areas where skin constantly rubs together like the underarms and inner thighs are common sites for HS lesions. Friction likely contributes to the chronic inflammation.
Who Gets Hidradenitis Suppurativa?
While anyone can develop HS, some key facts about who is most often affected include:
- More common in women - up to 3 times as many cases
- Often starts around puberty or early adulthood
- Higher rates in African Americans
- Obesity increases risk
- Smokers have higher incidence
- Family history in about 30% of patients
Stages of Hidradenitis Suppurativa
HS is often divided into three stages that describe the severity of the condition:
Stage 1
This early stage involves single or sporadic lesions with acute inflammation or abscesses. They have not yet tunneled or scarred extensively.
Stage 2
At this moderate stage, patients have recurrent flare ups with draining tunnels and scarring developing between lesions. However, entire areas are not yet diffusely affected.
Stage 3
The most severe stage involves diffuse, interconnected tracts and scars. Entire areas like the armpits or groin may be very inflamed and involved. Pain and drainage are frequent.
How is Hidradenitis Suppurativa Diagnosed?
HS is often diagnosed based on clinical symptoms, patient history, and a physical exam. Your doctor will likely ask about your symptoms and look for characteristic lesions and scarring patterns.
Medical History
Your doctor will ask about your full medical history, including:
- Symptoms - when they started, locations, severity, triggers
- Family history of HS
- Other medical conditions
- Current medications and supplements
Physical Exam
During the exam, your doctor will check areas like the underarms, groin, and under the breasts for signs of HS. This includes:
- Open or closed lesions
- Draining tunnels
- Scarring - amount and location
- Redness, swelling, tenderness
Other Tests
In some cases, additional tests may be ordered to rule out other skin diseases or infections. Tests can include:
- Skin culture
- Biopsy
- Blood tests
- Imaging - ultrasound, MRI, CT scan
Treatments for Hidradenitis Suppurativa
Treatment for HS focuses on managing symptoms and preventing flare ups. Options may include:
Medications
Topical, oral, and injected medications can help reduce HS inflammation, pain, and abscesses. Options include antibiotics, anti-inflammatory drugs, immunosuppressants, retinoids, hormones, and biologics.
Surgery
For severe or recurrent HS, surgery may be performed to remove affected tissue and drainage tracts. This can help reduce symptoms long-term. Techniques include excision, laser therapy, and deroofing.
Lifestyle Changes
Making healthy lifestyle adjustments can support HS treatment and management. This includes losing excess weight, quitting smoking, managing stress, wearing loose clothing, and practicing good hygiene.
Pain Management
Over-the-counter pain relievers, warm compresses, cold packs, and prescribed numbing creams can help manage HS discomfort during flares.
Wound Care
Properly cleaning and dressing open HS wounds helps prevent infection and supports healing. Your doctor can recommend medicated dressings.
Living with Hidradenitis Suppurativa
Dealing with HS takes a toll both physically and emotionally. Being proactive with self-care can help cope with life with this condition. Some tips include:
- Find a knowledgeable dermatologist for care
- Join a support group to connect with others
- Make necessary lifestyle changes
- Manage pain effectively
- Protect skin during flares
- Find healthy stress relief techniques
- Be open about your condition with loved ones
- Stay positive and focus on what you can control
Preventing Hidradenitis Suppurativa Flare Ups
FAQs
What are the first signs of hidradenitis suppurativa?
Early signs of HS include painful bumps, pimple-like lesions, and boils in areas like the armpits, groin, and under the breasts. These may leak pus and fluid when ruptured.
What foods trigger hidradenitis suppurativa?
Certain foods like dairy, gluten, soy, shellfish, eggs, yeast, nightshades, starchy foods, and sugars may trigger inflammation and HS flares in some people. An elimination diet can help identify personal food triggers.
Is hidradenitis suppurativa hereditary?
Yes, HS often runs in families and has a hereditary component. Around 30% of people with hidradenitis suppurativa have at least one affected first-degree relative.
Can stress cause hidradenitis suppurativa?
While stress does not directly cause HS, it can worsen symptoms. Stress management through relaxation techniques, therapy, exercise, social support, and other coping mechanisms can help.
What is the best diet for hidradenitis suppurativa?
An anti-inflammatory diet rich in fruits, vegetables, fish, healthy fats, probiotics, and antioxidants may help reduce HS flares. Avoiding known trigger foods can also help.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.
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