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HS presents itself in three stages.
Stage
Characteristics
I-Solitary or multiple isolated abscess formation without scarring or sinus tracts. (A few minor sites with rare inflammation; may be mistaken for acne.)
II-Recurrent abscesses, single or multiple widely separated lesions, with sinus tract formation. (Frequent inflammations restrict movement and may require minor surgery such as incision and drainage.)
III-Diffuse or broad involvement across a regional area with multiple interconnected sinus tracts and abscesses. (Inflammation of sites to the size of golf balls, or sometimes baseballs; scarring develops, including subcutaneous tracts of infection - see fistula. Obviously, patients at this stage may be unable to function.)
Causes
As this disease is poorly studied, the causes are controversial and experts disagree. However, potential indicators include:
post-pubescent individuals are more likely to exhibit HS
females are more likely than males
Possible genetic predisposition among families of Sephardic Jewish, Italian, French, Dutch, Greek, Middle Eastern and Northern African Ancestry.
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
sometimes linked with other auto-immune conditions
androgen dysfunction
genetic disorders that alter cell structure
stress can bring on outbreaks
being overweight makes it worse, however this condition is not caused by obesity and weight loss will improve but not cure it. Patients with more advanced cases may find exercise intolerably painful, which may increase the rate of obesity among sufferers.
The historical understanding of the disease is that there is a dysfunctional apocrine glands or dysfunctional hair follicles, possibly triggered by a blocked gland, creating inflammation, pain, and a swollen lesion. More recent studies imply there is an autoimmune component.[citation needed]
HS is not caused by any bacterial infectionny infection is secondarynd is therefore not contagious. Most cultures done on HS lesions come back negative for bacteria, so antibiotics should be used only when a bacterial infection has been confirmed by a physician.[citation needed]
Severe complications
In disease stage III, fistulas left undiscovered, undiagnosed, or untreated, can lead to the development of squamous cell carcinoma, a rare cancer, in the anus or other affected areas. Other stage III chronic sequelae may also include anemia, multilocalised infections, amyloidosis, and arthropathy. Stage III complications have been known to lead to death, but clinical data is still uncertain.
Treatments
Treatments may vary depending upon presentation and severity of the disease. Due to the poorly-studied nature of this disease, the effectiveness of the drugs and therapies listed below is not yet clear, and patients should discuss all options with their doctor or dermatologist. Nearly a quarter of patients state that nothing relieves their symptoms. A list of treatments that are possible treatments for some patients is as follows.
This section does not cite any references or sources.
Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (July 2009)
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
Medication
Antibiotics orally.These are used for their anti-inflammatory properties rather than to treat infection. The most effective is a combination of Rifampicin [300 mg twice a day] and Clindamycin [300 mg twice a day] given concurrently for 23 months. This brings about remission in around three quarters of cases.
Hexachlorophene shower with liquid soap like Phisohex, covering sores with Metrolotion after medicated showers.
Corticosteroid injections.
Vitamin A supplementation
Anti-androgen therapy
IV or subcutaneous infusion of anti-inflammatory (anti-TNF-alpha) drugs such as infliximab (Remicade), etanercept (Enbrel), and adalimumab. This use of the drugs is not currently Food and Drug Administration (FDA) approved and is somewhat controversial, and therefore may not be covered by insurance.
Acitretin
Zinc gluconate taken orally has been shown to induce remission
Chlorhexidine (Hibiclens) plus an antibiotic soap for cleansing the skin surface
Tetracycline
Tea Tree Oil & Tea Tree Oil Body Wash for cleansing the skin surface
Turmeric capsules orally or through topical application
References
^ a b c d 'HS-USA :: What is Hidradenitis Suppurativa?'. http://www.hs-usa.org/hidradenitis_suppurativa.htm. Retrieved 2007-07-08.
^ Gao M, Wang PG, Cui Y, et al. (2006). 'Inversa acne (hidradenitis suppurativa): a case report and identification of the locus at chromosome 1p21.1-1q25.3'. J. Invest. Dermatol. 126 (6): 13026. doi:10.1038/sj.jid.5700272. PMID 16543891. http://www.nature.com/jid/journal/v126/n6/abs/5700272a.html.
^ 'HS-USA :: Prevalence of Hidradenitis Suppurativa'. http://hs-usa.org/pub/articles/prevalence.htm. Retrieved 2007-07-08.
^ Sellheyer K; Krahl D. (2005 July). ''Hidradenitis suppurativa' is acne inversa! An appeal to (finally) abandon a misnomer.'. International Journal of Dermatology. 44 (7): 53540.
^ Bazex, J, Bayle, P, San, B. (2007). 'Hidradenitis suppurativa is acne inversa.'. International Journal of Dermatology 46: 330.
^ Scheinfeld N (2006). 'Hidradenitis should not be renamed acne inversa'. Dermatol. Online J. 12 (7): 6. PMID 17459292.
^ Verneuil AS: Etudes sur les tumor de la peau. Arch Gen Med 1854; 94: 693.
^ a b DermNet acne/hidradenitis-suppurativa
^ ClinicalTrials.gov NCT00329823 Etanercept in Hidradenitis Suppurativa
^ 'HSF - What is Hidradenitis Suppurativa? What is HS?'. http://www.hs-foundation.org/abouths/what.htm. Retrieved 2007-07-08.
^ Talmant JC, Bruant-Rodier C, Nunziata AC, Rodier JF, Wilk A (2006). '[Squamous cell carcinoma arising in Verneuil\'s disease: two cases and literature review]' (in French). Ann Chir Plast Esthet 51 (1): 826. doi:10.1016/j.anplas.2005.11.002. PMID 16488526.
^ Short KA, Kalu G, Mortimer PS, Higgins EM (2005). 'Vulval squamous cell carcinoma arising in chronic hidradenitis suppurativa'. Clin. Exp. Dermatol. 30 (5): 4813. doi:10.1111/j.1365-2230.2005.01875.x. PMID 16045671. http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2230.2005.01875.x.
^ 'abscesses.org - About Hidradenitis Suppurativa'. http://abscesses.org/hidradenitisSuppurativa/content/view/22/33/. Retrieved 2007-07-08.
^ Cusack C, Buckley C (2006). 'Etanercept: effective in the management of hidradenitis suppurativa'. Br. J. Dermatol. 154 (4): 7269. doi:10.1111/j.1365-2133.2005.07067.x. PMID 16536817.
^ Scheinfeld N (2006). 'Treatment of coincident seronegative arthritis and hidradentis supprativa with adalimumab'. J. Am. Acad. Dermatol. 55 (1): 1634. doi:10.1016/j.jaad.2006.01.024. PMID 16781316.
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