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HS cysts can be extremely tender and may persist for years with interspersed periods of inflammation, culminating in incision and drainage of pus from the cyst.
This process often forms open wounds that will not heal and frequently leads to significant scarring.
For unknown reasons, people with HS develop plugging of their apocrine glands.
Incision and drainage procedures may provide symptomatic relief.
HS flares may be triggered by sweating, hormonal changes related to the menstrual cycle, humidity and heat, and friction from clothing.
Persistent lesions may lead to 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 is variable, with some experiencing remission for months to years at a time, while others may worsen and require multiple surgeries.
HS often goes undiagnosed for years due to a delay in seeking treatment and is frequently misdiagnosed.
Sometimes sinus tracts (tunneling) will form underneath the skin that connects the nodules.
Scarring is usually left behind when the nodules heal.
Hidradenitis Suppurativa usually starts after puberty.
Flare ups can occur over many years.
The symptoms tend to worsen over time..
There are 3 stages of Hidradenitis Suppurativa.
Stage 1 is given for one or a few isolated nodules that do not tunnel or scar.
Stage 2 is given for recurrent nodules that form in more than one area of the body and starting to form sinus tracts.
Stage 3 is given when there are widespread nodules that form many sinus tracts.
It can also include scarring, abscesses, and pus leakage.
Nodules can enlarge over as short as a few hours or over a few days.
Once the nodule has healed, raised or rope-like scarring is left behind.
The skin can become pitted and discolored.
Scar tissue and pain from open sores can cause restricted movement.
The nodules are located in areas where there is skin to skin friction.
Nodules will most likely form on the groin, armpits, underneath the breasts, or between the buttocks, however, it is possible for it to be located elsewhere on the body.
Depression, anxiety, or a sense of being self-conscious can occur due to the pain, appearance of the nodule, odor if infected, and/or the scarring.
Blackheads, appearing in pairs, are common.
The nodules tend to heal slowly, causing an abscess.
Nodules may be found in one part of the body or in different areas of the body.
Sometimes a painful lump can develop underneath the skin and persist for months.
It is rare, but Hidradenitis Suppurativa may trigger a type of skin cancer, squamous cell carcinoma, to develop.
In the rare case that skin cancer occurs, it is usually in men who have had this condition for a long time, with the nodules being located around the anus and genitals.
Nodules reoccur when a person is having a flare up, then scar over again once it's healed.
If the tunneling doesn't resolve, a fistula can occur, which can be painful and require surgery to close.
A fistula is when the sinus tracts tunnels into a body part or organ in the body.
Lumps usually start out the size of a pea but can quickly grow to the size of a golf ball if left untreated.
A small hole at the top of the skin may form called a pilonidal sinus.
A pilonidal sinus is often found at the top of the buttocks where it starts to separate.
Some people only have mild cases of Hidradenitis Suppurativa and some people have moderate or severe cases.
The cause of HS remains unknown and experts disagree over proposed causes.
Post-pubescent individuals are more likely to exhibit HS.
Plugged apocrine (sweat) gland or hair follicle.
Patients with more advanced cases may find exercise intolerably painful, which may increase the rate of obesity among sufferers.
Infection can cause the pus to have a foul odor.
Stress can cause the symptoms to worsen.
It is not caused by poor hygiene.
Hidradenitis Suppurativa can occur at any age but usually starts after puberty, usually in the teens and early 20's.
Hormones can play a role, though not enough information is understood as to how it plays a role.
People with this disease may already have issues with acne.
People with hirsutism may be at a higher risk.
Hirsutism is excessive hair growth, mainly in women, where hair usually doesn't grow, such as the chin or above the lips.
Hidradenitis Suppurativa can occur in anyone but has a higher prevalence in women.
If the lymphatic duct in the area where the nodule was located becomes blocked due to scarring, the area or body part might swell too, causing Lymphedema.
Some women report an increase in symptoms right before the start of their period.
The doctor might refer the patient to a Dermatologist.
A doctor can usually make a diagnosis of Hidradenitis Suppurativa by examining the skin.
A sample of pus drainage and blood work may be sent for testing.
A sample of pus can reveal which type of bacteria is present and what type of antibiotic should be used.
An ultrasound can be used to reveal abnormalities within the hair follicle.
Tests can be performed to exclude other disease or conditions if the doctor is unsure if it is truly Hidradenitis Suppurativa.
CT scans are not needed to diagnose Hidradenitis Suppurativa but can be useful in viewing structures and sinus tracts underneath the skin if surgery is planned.
There is no cure for Hidradenitis Suppurativa.
Early treatment can hinder the disease from becoming severe and prevent new lesions from occurring.
Antibiotics can be in pill form or by cream.
A long-term course or a short-term course of antibiotics can be prescribed.
Treatments may vary depending upon presentation and severity of the disease.
Nearly a quarter of patients state that nothing relieves their symptoms.
Washing with benzoyl peroxide can be effective.
Corticosteroids can be injected into the nodule to reduce inflammation.
Prednisone can be helpful too but long-term usage has many side effects.
Benzoyl Peroxide can help rid the area of bacteria and also dry out the abscess.
Weight loss in overweight and obese patients, as well as smoking cessation can improve or even alleviate many symptoms of hidradenitis suppurativa.
When the process becomes chronic, wide surgical excision is the procedure of choice.
Wounds in the affected area do not heal by secondary intention, and immediate application of a split thickness skin graft is more appropriate
Retin-A medications can help by stopping the secretion of sebum and also by preventing the blocking of hair follicles by causing dead skin cells to shed.
Retin-A should not be used by pregnant women due to the increased risk of birth defects.
Tumor Necrosis Factor (TNF) Alpha Inhibitors, such as Remicade or Humira, can be used but can result in serious side effects.
Cyclosporine suppresses the immune system and has been helpful to some but can have many side effects.
Surgery can be performed if other treatments are not helping.
Incision and drainage is a type of surgery where an incision is made into the nodule and the pus is drained.
Surgical removal involves removing all of the skin in the affected area.
A skin graft may be required to replace the removed skin.
Tunnels or sinus tracts can be removed during this procedure if present.
Carbon Dioxide Laser Treatment involves vaporizing nodules and leaving the open wound to heal.
Laser treatment is a fairly new procedure and some doctors might still consider it experimental.
Cryotherapy involves freezing the nodules off with liquid nitrogen.
Loose fitting clothing should be worn to reduce skin irritation.
Do not shave the affected area.
Warm compresses can reduce inflammation.
Over the counter anti-inflammatory medications may be helpful.
Keep the area clean, wash the area with antibacterial soap, and properly dress or treat open wounds.
Losing weight might improve symptoms by reducing skin to skin friction.
If Lymphedema occurs, a compression stocking can be used to help lymph fluid to flow.
Icing the inflamed area daily until pain reduction is noticed.
Vitamin A supplementation.
Electron beam radiotherapy has been a successful treatment of hidradenitis.
Since the exact cause of Hidradenitis Suppurativa is unknown, the actual disease is not preventable.
Avoid smoking, which is an increased risk.
If obese, try safely losing weight to reduce the symptoms of the disease.
Try to keep stress at a minimum to avoid an increase in symptoms.
Seek immediate treatment at the beginning of a flare up to keep it from worsening.
Not all people with Hidradenitis Suppurativa will progress to stage 3.
Early detection and treatment can keep the disease from progressing.
Approximately 1% of the population is said to have this disease but it's possible that the numbers are much higher.
The numbers might be much higher than reported because some people may not be seeking treatment if they have a mild case.
When mild cases are considered, it is thought that Hidradenitis Suppurativa affects 1 in 100 people.
Women are 2-3 times more likely to suffer from Hidradenitis Suppurativa than men.
In people with a comprised immune system, due to chronic infection that is sometimes associated with this disease, it can prove to be fatal.
However, fatalities are very rare.
About 50% of people with Hidradenitis Suppurativa have also experienced severe acne.
Approximately 1/3 of patients appear to have inherited this disease.
Hidradenitis Suppurativa is also known as acne inversa.
Hidradenitis Suppurativa is characterized by very painful pus-filled lumps or nodules that form around hair follicles.
It is a chronic condition involving areas where the apocrine glands are located, which are sweat glands that appear on certain parts of the body.
The nodules tend to form in areas where the skin rubs together.
Common areas for the nodules to grow are the armpits, groin, underneath the breasts, and between the buttocks..
One of the main symptoms of Hidradenitis Suppurativa is a very painful nodule, or nodules, that are filled with pus.
The nodules may be connected by tunneling.
The nodule is inflamed, red, and swollen.
The nodules open at the surface of the skin, draining clear or yellow pus.
If the nodule is infected, the pus may have a foul odor.
The exact cause of Hidradenitis Suppurativa is unknown.
It can develop when hair follicles become blocked or inflamed but it is not known why the follicles become blocked in the first place.
Genetics appear to be a factor in developing this condition and it does appear to run in families.
Obesity increases the risk of developing this disease and also the severity of the symptoms, though obesity itself does not cause the disease.
Smoking can increase symptoms and increase the risk of developing the disease.
Due to the poorly studied nature of this disease, the effectiveness of the drugs and therapies listed below is unclear, and patients should discuss all options with their physician or dermatologist.
Antibiotics can fight infections and prevent the disease from worsening.
Changes in diet avoiding inflammatory foods and foods high in refined carbohydrates.
Warm compresses with distilled vinegar water, and taking hot baths with distilled white vinegar in the water.
Birth control pills have been helpful in some women for controlling Hidradenitis Suppurativa but can have side effects.