Treatment for Hidradenitis Suppurativa

Hidradenitis suppurativa is a chronic condition that affects sweat glands

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Smoking is a terrible habit that can kill you. Smoking is bad for your lungs, your heart ... and your skin.  Yes, smoking can even affect your skin. Specifically, if you smoke, your risk for hidradenitis suppurativa increases. (Smoking also causes wrinkles.)  

Hidradenitis is an inflammatory condition similar to a really bad case of acne which usually only affects sweat glands in the armpits and groin.

With severe cases, hidradenitis is treated with surgery or immunomodulators.

What Is Hidradenitis?

In addition to affecting the armpits and groin, hidradenitis can also affect other areas rich in apocrine sweat glands including the upper thigh and anus. (Very rarely, hidradenitis can also plague the real estate around the belly button or ear.)

Hidradenitis first blocks hair follicles and then blocks the surrounding sweat glands. This blockage is accompanied by inflammation and infection which makes this condition painful and uncomfortable.

People with hidradenitis present with blackheads and abscesses or boils which can connect via tunnels (fistulas) under the skin. Hidradenitis also causes pus drainage, pimples, nodules, cysts and scarring.

Hidradenitis is more common among women, African Americans, people who are obese, people with diabetes and people who have acne. Hidradenitis usually first presents in young adulthood and can flare up during menses.

Oftentimes, the course of hidradenitis waxes and wanes. One week a person can present with painful, red, blood-and-pus-drenched armpits, and the next week all that remains is scarring, only to have the cycle repeat several days or weeks later.

Smoking cessation and weight loss—even as little as 10 percent of your body weight—can alleviate symptoms of hidradenitis.

However much like a pilonidal cyst, hidradenitis is not usually something that goes away on its own. Instead, hidradenitis becomes worse without prompt treatment. In other words, early diagnosis and treatment is key to relief. (Whereas a pilonidal cyst is usually cured with surgery, most treatments for hidradenitis only reduce symptoms.)

Hidradenitis Treatment

The goals of treatment vary according to the patient and include:

  • reduction of breakouts
  • clearing of breakouts
  • prevention of breakouts
  • getting rid of scars
  • getting rid of tunnels under the skin (fistulas)

Various treatments for hidradenitis exist including the following:

  • antibiotics, which curb inflammation and help fight infection
  • bleach baths
  • acne washes
  • acne medicines
  • birth-control pills
  • methotrexate, which dampens the immune system response
  • corticosteroid injections
  • radiation therapy which carries the burden of radiation exposure and is used less commonly today than in the past
  • wound dressing
  • oral retinoids, which have been shown to help a minority of patients

    Typically, no one medication or non-surgical treatment is effective when treating hidradenitis; instead, treatments are combined.

    When hidradenitis extends deep into the skin, surgery is the best option; surgical options include laser treatment, incision and drainage, deroofing, and excision (taking the affected areas out).

    Unfortunately, a minority of people have particularly severe hidradenitis that is resistant to the above non-surgical treatments. Moreover, these people are poor surgical candidates due to the sheer extent of their lesions. For this patient population, in 2015 the FDA approved a biologic agent or immunomodulator called adalimumab (Humira). 

    Adalimumab works to reduce inflammation mediated by the immune system. In clinical trials, adalimumab has proven to be rapidly effective at not only reducing inflammation but also the number of nodules and abscesses that accompany hidradenitis.

    Bottom Line

    If you or someone you love is suffering from hidradenitis, please be sure to make an appointment with a primary care physician or dermatologist. (You may eventually be referred to a surgeon for treatment.) There's no reason to endure this uncomfortable condition especially when effective treatments exist.

    Sources

    Usatine RP, Smith MA, Chumley HS, Mayeaux EJ, Jr. Chapter 115. Hidradenitis Suppurativa. In: Usatine RP, Smith MA, Chumley HS, Mayeaux EJ, Jr.. eds. The Color Atlas of Family Medicine, 2e. New York, NY: McGraw-Hill; 2013.

     Zarchi K, Dufour D, Jemec GE. Successful Treatment of Severe Hidradenitis Suppurativa With Anakinra. JAMA Dermatol. 2013;149(10):1192-1194.

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