What is hidradenitis suppurativa?

Hidradenitis or hidradenitis suppurativa is a skin disease that affects the hair and sweat organs. It is manifested by lumps, abscesses and pustules that appear mainly in the armpits, the groin, the genital area, or the breasts.

It can be very annoying, painful, and very disabling, since it causes suppuration, bad smell, chronic pain and difficulties in daily life.

How is it produced?

The hydradenitis patient is believed to have a genetic defect that predisposes to inflammation and breakdown of hair structures, the sebaceous gland, and the sweat gland in the affected areas. Other factors such as overweight, friction, poor hygiene and smoking act on this terrain, causing a very intense inflammatory process. In the long run, the disease can cause scars, and fistulas that go under the skin and generate other areas of suppuration.

It should be understood that hidradenitis is not simply an infectious disease. Although it temporarily improves with antibiotics, the microbes that colonize the lesions belong to the normal flora of the skin. In any case, what occurs is an exaggerated reaction against this flora, in the context of an autoinflammatory disease, in which the skin's own defenses react in the wrong way, causing a very destructive inflammation.

Symptoms

Patients may start with small, inflamed bumps (commonly known as "swallows") in the folds, which are itchy and painful. In general, the first symptoms appear in adolescence. If the disease continues its course, these lumps grow, are accompanied by pimples of pus, and can form abscesses that ooze and spread. If the evolution is unfavorable, fistulas and retractile scars appear that hinder the mobility of the area.

Hidradenitis has a very intense impact on the life of the patient, since they generate pain, a bad smell, constant suppuration, and in many cases it affects the genital areas, creating relationship problems. Many patients may manifest social rejection and depression.

Is it associated with other diseases?

It has been discovered that patients with hidradenitis can suffer from other diseases such as certain types of rheumatism, inflammatory bowel disease, and psoriasis. As patients may be overweight or obese, and many of them smoke, it is more common for them to develop the so-called metabolic syndrome earlier, which combines hypertension, obesity and diabetes. Overall, the chronic and sustained inflammation caused by hidradenitis can affect the body as a whole, and must be well controlled with treatment to avoid potentially serious complications.

Diagnosis or how it is diagnosed

It is a disease that a dermatologist usually diagnoses with the naked eye, without the need for an analysis or a biopsy. It may happen that other non-dermatology doctors such as surgeons or emergency physicians do not diagnose it correctly, simply calling it “abscesses” or “cysts”. Misdiagnosis can lead to poor treatment. It is important that the disease is diagnosed and treated by a dermatologist. MAPFRE Health Insurance has a large medical team specialized in dermatology.

Treatment

The disease has traditionally been treated with surgery, removing the affected areas and rebuilding the area with grafts or flaps. However, they are very complex interventions with long and uncomfortable postoperative periods. Very unsightly and poorly functional scars can be caused. In addition, if it affects many areas of the body, the operations can be many and very mutilating.

There are also medications that reduce inflammation such as antibiotics, sulfone, acitretin, methotrexate, and corticosteroids, and they can be used with some success in hidradenitis. However, the most recent revolution for the disease has been biological treatment, with drugs designed and produced with a very complex technology that are capable of blocking the inflammatory process at the point of interest.

Of these, the one that has shown the greatest efficacy is adalimumab and it is already approved for treatment. It is administered subcutaneously with a self-injectable pen similar to that used by diabetics. In our country it is a medicine for hospital use only, and it cannot be purchased at a pharmacy. Its cost is usually covered by public health and some private insurance. It should be indicated by a dermatologist.

Precautionary measures

As it is a disease that is associated with overweight and obesity, which enhance certain aggravating factors such as friction and sweat, patients must eat a healthy diet and stay slim. They should also give up smoking, because it increases inflammation in the skin and makes the disease worse. In some cases, the definitive of the groin or the armpits with laser or pulsed light can help to slow the progression if it is done in the initial phases. It is important to maximize hygiene and ventilation of the affected areas. Certain jobs that require sitting still and that cause heat and sweat tend to make hidradenitis worse.