Purulent hidradenitis (Hidradenitis suppurativa, or HS as it is often called) is a chronic skin disease that occurs in areas of the body with sweat glands, often in the armpits or groin. The disease often starts in teens and early adulthood but can appear as early as childhood in patients who are genetically predisposed. The disease affects around 1% and occurs more often in women.
Hidradenitis is an inflammation of the hair follicles in areas of the body with sweat glands, most commonly in the armpits or groin. It can also occur around the genitals, anus, or under the breasts in women. The typical presentation is the formation of tender, red nodules in the skin that can develop into abscesses. The abscesses can burst and discharge pus. The inflammation often extends deep into the skin, forming sinus tracts, and can result in the formation of scars.
Hidradenitis is usually a chronic condition with fluctuating intensity. The affected areas are often sensitive and painful. The oozing and pus discharge can cause a foul odour, which can be socially and personally distressing.
Hidradenitis is not an uncommon condition, affecting approximately 1% of the population. The condition often begins during puberty but can also occur up to the age of 40. Women are affected by the condition four times more frequently than men. Despite causing significant discomfort, it takes an average of 7-8 years from the onset of symptoms until a diagnosis is made, likely because many people perceive it as highly stigmatized. During this period, many individuals become unable to work, and for some, the disease leads to social isolation.
The exact causes of the disease are not fully understood, but it appears to have a hereditary component – up to 40% of individuals with the condition have multiple cases in their family. It likely also has a hormonal component, and some individuals experience worsening symptoms in relation to menstruation. The condition is more common and can be more severe in individuals who smoke or are overweight.
The condition is not caused by poor hygiene, and it is not contagious.
Quitting smoking is crucial as smoking leads to reduced blood circulation in the outer layers of the skin, and the body's ability to repair the damage is significantly weakened. If you are overweight, weight reduction can help alleviate symptoms.
It is advisable to wear loose-fitting clothing to avoid friction on the sores. Avoid hair removal and shaving as they can cause minor skin injuries. Do not squeeze or apply pressure on new nodules.
Gentle daily cleansing can reduce odour and prevent infection. Use a mild soap with a neutral pH. Alternatively, you can use chlorhexidine periodically.
There is no definitive cure for the condition. Treatment aims to primarily reduce symptoms, and frequency of flare-ups, and prevent the progression of the disease with the formation of fistulas/tracts and scarring in the skin.
Mild cases may be treated with topical antibiotic creams during flare-ups. Surgical treatment involving the removal of the affected skin may be considered. In cases of acute, painful abscesses, it may be necessary to open and drain them.
For moderate disease extent, as well as acute infections and exacerbations, oral antibiotic treatment (such as tetracyclines) is recommended. Treatment is typically required for several weeks.
Moderate to severe cases should be promptly evaluated by a dermatologist or plastic surgeon. Early treatment can reduce the risk of developing more severe disease and fistula and scarring formation.
Surgical treatment is considered early in the course of the disease, involving the removal of the affected skin. This can be done through traditional surgery or by using laser techniques. Surgery is particularly suitable when the skin lesions are confined to a smaller area. In cases of recurrent or persistent symptoms, biological treatment may be considered.
At Dr. Dropin, we have one of Norway's most experienced dermatologists in the treatment of purulent hidradenitis, Olav Gramstad. You can book an appointment directly with Olav Gramstad by following the link below.
First consultation: 1395 NOK. During the first consultation, Olav will examine you and assess further treatment measures. You will also receive information about the pricing for subsequent treatments.
