Acne inversa, also known as hidradenitis suppurativa, is a condition characterised by the formation of painful, small lumps beneath the skin. These lumps typically appear in areas where skin friction occurs, such as the armpits, groyne, buttocks, and breasts. They have a slow healing process, tend to recur, and can result in the formation of tunnels under the skin and scarring.

However, a combination of medical and surgical treatments can effectively manage the disease and prevent complications. The likelihood of developing hidradenitis suppurativa is three times higher in women, although this ratio may vary depending on the geographical location.

Symptoms of HS

Discomfort in the affected skin area

Prior to the emergence of a lump on your skin, you may experience some discomfort. The area where the lump is about to appear might become swollen. Some people report a sensation of burning, itching, or excessive sweating in their skin.

Development of spots

The initial indication of hidradenitis suppurativa (HS) often appears as a tender and deep spot resembling a pimple, acne cyst, or boil. This spot commonly emerges in the armpit or in the groyne region. Some people may experience a similar spot on their buttocks or inner thigh.

Nodules

As the HS condition advances, the number of nodules increases, which can resemble acne or boils. These nodules have the potential to grow in size and merge with one another. Consequently, as the nodules amalgamate, they become filled with fluid and cause considerable pain. These painful, merged nodules are referred to as abscesses.

Abscess ruptures

Once an abscess ruptures, a combination of blood and pus is released, resulting in the emergence of wet stains on garments. The unpleasant odour accompanying this mixture can lead to feelings of embarrassment among individuals.

Tunnels

Abscesses have a slow and often incomplete healing process, frequently recurring, and resulting in the formation of scars. Over time, the repetitive cycle of healing and reopening can lead to the development of sinus tracts, creating permanent tunnels beneath the skin. Consequently, people with HS may experience persistent skin wounds, while for others, scars might be the sole visible indication of the condition for a period of time.

Causes

The exact causes of hidradenitis suppurativa are not fully understood, but it is believed that the formation of nodules is often a result of blocked hair follicles. The development of hidradenitis suppurativa may also be influenced by sex hormones, as most individuals first experience symptoms after reaching puberty. Another potential factor in the development of hidradenitis suppurativa is the immune system. One theory suggests that the immune system may overreact to minor infections occurring in obstructed hair follicles.

There appears to be a genetic component to hidradenitis suppurativa, as many individuals with the condition have a family member who is also affected. There are several factors and medications that can increase the risk of developing hidradenitis suppurativa. These factors include:

• Being female

• Being overweight or obese

• Smoking

• Taking lithium

• Additionally, individuals with hidradenitis suppurativa may have a higher likelihood of having certain other health conditions, such as:

• Acne

• Hirsutism (excessive hair growth)

• Metabolic syndrome

• Diabetes

• Polycystic ovary syndrome (PCOS)

• Inflammatory bowel disease (IBD)

• Heart disease

• Depression

It's important to note that according to the American Academy of Dermatology Association, poor hygiene is not a cause of this condition, and it is not contagious.

Management

Antibiotics

These medications can be taken orally or applied topically to decrease inflammation, combat bacterial infections, and prevent new outbreaks. Commonly prescribed options include tetracyclines or a combination of clindamycin and rifampin.

Biologic medications

Currently, the Food and Drug Administration (FDA) has approved Adalimumab as the sole treatment for HS(Hidradenitis Suppurativa. Additionally, other drugs like infliximab, etanercept, and golimumab (Simponi) may be used off-label for this condition.

Steroids

Steroids, whether administered orally or through injections, can effectively diminish inflammation and alleviate symptoms. People experiencing moderate to severe symptoms may receive prescriptions for low doses of corticosteroids or systemic steroids, such as prednisone. However, prolonged usage of steroids may result in significant side effects.

Hormone treatments

Recent studies indicate that hormone therapy can be as effective as antibiotics in treating HS in women. Antiandrogen therapy, which aims to minimise the impact of hormones like testosterone, has shown promising results. Additionally, the off-label use of the diabetes drug metformin may benefit individuals with both HS and metabolic syndrome.

Retinoids

Retinoids, derived from vitamin A, are medications commonly prescribed for acne treatment. Acitretin or isotretinoin are commonly prescribed by doctors. 

Surgical alternatives

In cases of severe and recurrent HS, surgery can be considered to alleviate the condition by draining or eliminating deep skin lesions.

However, it's important to note that after undergoing surgery, HS may reoccur in the same location or appear in a different area of the body.

Conclusion

Coping with HS can pose challenges, but there are potential solutions that can alleviate pain and enhance your well-being. As researchers persist in their investigations, advancements in treatments are on the horizon, promising new possibilities for improved management of the condition.

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