Hidradenitis suppurativa is a chronic inflammation of the skin that appears in the apocrine sweat glands, which are the glands that produce sweat, causing symptoms such as painful lumps or nodules under the skin, or abscesses that can rupture and release pus, leaving scars on the skin when disappear.
Hidradenitis suppurativa, also called hidradenitis suppurativa or acne inversa, is more common to appear in the armpits, groin, anus and buttocks, for example, which are areas of the body that are normally stuffy and produce a lot of sweat.
It is important to consult a dermatologist whenever symptoms of hidradenitis suppurativa appear, so that it can be diagnosed and the most appropriate treatment can be indicated, which may involve the use of anti-inflammatory medications, antibiotics or corticosteroids, or even surgery.
Symptoms of hidradenitis suppurativa
The main symptoms of hidradenitis suppurativa are:
- Burning or stinging sensation on the skin;
- Itching in the affected region;
- Excessive sweating in the region;
- Deep, firm and painful lumps or nodules on the skin;
- Lumps on the skin that measure about 0.5 to 2 cm and last days to months;
- Abscesses like pus;
- Intense redness in the affected area;
- Formation of channels beneath the pits;
- Scars or fibrotic plaques on the skin.
Lumps caused by hidradenitis suppurativa may shrink spontaneously or burst, releasing foul-smelling pus, before the skin heals. In some people, after a few weeks or months, the nodules return, usually in the same previously affected area.
In cases where several nodules appear or when they are constant and take a long time to heal, the wounds can enlarge and form abscesses or ulcers, making them more difficult to treat and requiring surgery.
Generally, people who have this hidradenitis suppurativa may think they have boils, but the characteristics of these diseases are different, as in hidradenitis the nodules leave scars on the skin, which does not happen with boils. Learn how to identify and treat boils.
What are the most affected regions?
The regions of the body most affected by hidradenitis suppurativa are the groin, perineum, anus, buttocks and armpits, but this disease can also appear in the crease of the breasts, inner thighs, neck and waist. Learn about other causes of lumps in the armpits.
How to confirm the diagnosis
The diagnosis of hidradenitis suppurativa is clinical, made by a dermatologist, through the evaluation of symptoms, health history and physical examination evaluating the characteristics of the affected skin.
Generally, no additional tests are necessary to confirm the diagnosis, however, in the case of severe hidradenitis suppurativa or when there is diagnostic doubt, the doctor may request a skin biopsy to rule out squamous cell skin cancer. See how a skin biopsy is performed.
Possible causes
Hidradenitis suppurativa is caused by inflammation of the apocrine glands that produce sweat, due to an obstruction in the hair follicle, changes in the skin’s microbiota, or the release of inflammatory substances, such as cytokines.
Some factors may increase the risk of developing hidradenitis suppurativa, such as:
- Family history of hidradenitis suppurativa;
- Obesity or overweight;
- Insulin resistance;
- Hormonal, estrogen or androgen changes;
- Smoking habit.
Furthermore, hidradenitis suppurativa is more common in women than in men, due to hormonal changes between puberty and menopause.
How the treatment is carried out
The treatment of hidradenitis suppurativa should be guided by a dermatologist, with the aim of relieving symptoms and preventing the lumps from worsening or reappearing.
The main treatments for hidradenitis suppurativa that may be recommended by your doctor are:
- Nonsteroidal anti-inflammatory drugssuch as paracetamol, to relieve pain and discomfort;
- Antibiotics, such as clindamycin, in the form of an ointment to be applied to the affected area or tablets to be taken orally;
- Corticosteroid injection directly into the nodules to reduce inflammation during periods of crisis or used in tablet form to try to prevent or delay crises;
- Antiandrogenic hormone therapysuch as cyproterone acetate, oral contraceptives, spironolactone or finasteride;
- immunomodulators, such as adalimumab, to reduce the immune response and, therefore, reduce the chances of developing new inflamed nodules;
- Anticonvulsantssuch as gabapentin or pregabalin, to relieve chronic pain.
Furthermore, in more serious cases, it may be necessary to have surgery to eliminate the area of skin affected by the defective glands.
Other treatments that may be recommended by your doctor to help reduce inflammation of the affected skin are laser treatment or pulsed light therapy.
Some general precautions must also be taken during treatment in all cases, such as maintaining adequate hygiene of the area, avoiding the use of tight clothing and applying moist compresses to the wounds.
- GOLDBERG, S. R.; et al. Hidradenitis suppurativa: Epidemiology, clinical presentation, and pathogenesis. J Am Acad Dermatol. 82. 5; 1045-1058, 2020
- SAUNTE, DML; JEMEC, GBE Hidradenitis Suppurativa: Advances in Diagnosis and Treatment. JAMA. 318. 20; 2019-2032, 2017
- SABAT, R.; et al. Hidradenitis suppurativa. Nat Rev Dis Primers. 6. 1; 18, 2020
- BALLARD, K.; SHUMAN, V. L. IN: STATPEARLS (INTERNET). TREASURE ISLAND (FL): STATPEARLS PUBLISHING. Hidradenitis suppurativa. 2022. Available at: <https://www.ncbi.nlm.nih.gov/books/NBK534867/>. Accessed on January 25, 2023
- VITORAZZI, Aneliza et. al. Definitive treatment of hidradenitis suppurativa with flaps and grafts at the Hospital das Clínicas of the Faculty of Medicine of Ribeirão Preto – FMRP – USP. Rev. Bras. Cir. Plastic Vol 26. 102, 2011
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