What is Hidradenitis Suppurativa

TL;DR: Hidradenitis suppurativa, also known as acne inversa, is a chronic, inflammatory skin condition characterized by the development of painful, recurring nodules, abscesses, and sinus tracts in areas where skin rubs together, such as the armpits and groin. It is a systemic disease that involves immune system dysregulation, often leading to significant scarring and a profound impact on quality of life.

What exactly is Hidradenitis Suppurativa?

Hidradenitis suppurativa is a long-term skin condition that causes painful lumps deep under the skin. Unlike typical acne, these lesions often occur in areas with apocrine sweat glands and are prone to rupture, leaking pus and causing tunneling under the skin, known as sinus tracts. Over time, this cycle of inflammation and healing leads to permanent scarring. Because the condition is systemic, it affects multiple body systems, including the immune, endocrine, and skeletal systems, rather than being just a localized skin issue.

How does Hidradenitis Suppurativa affect the body?

While the skin is the primary site of symptoms, hidradenitis suppurativa is a multi-systemic disorder. The pathophysiology involves a blockage of the hair follicle combined with an overactive immune response. This chronic inflammation can have far-reaching effects:

• Immune System: Constant systemic inflammation is a hallmark of the disease.


• Endocrine System: Hormonal fluctuations, particularly androgens, are known to exacerbate flare-ups.


• Circulatory System: Chronic inflammation is linked to an increased risk of cardiovascular comorbidities.


• Skeletal System: In rare, severe cases, chronic inflammation can be associated with spondyloarthropathy (joint inflammation).

Who is typically affected by the condition?

Hidradenitis suppurativa most commonly begins after puberty, typically appearing between the ages of 20 and 40. While it can affect anyone, clinical data indicates it is three times more common in women than in men. Prevalence estimates vary widely due to underdiagnosis, but studies suggest it affects approximately 0.1% to 4% of the general population. Within the DiseaseMaps.org community, 729 people with hidradenitis suppurativa have connected to share their experiences and navigate the complexities of this diagnosis.

How is this different from other skin conditions?

It is common for hidradenitis suppurativa to be misdiagnosed as simple boils or standard acne. However, several key factors differentiate it:

1. Anatomic Location: It occurs in intertriginous areas (where skin touches skin) like the axilla, groin, perineum, and under the breasts.


2. Recurrence: Lesions are persistent and tend to recur in the exact same spots.


3. Sinus Tracts: The development of tunnels connecting abscesses under the skin is a definitive clinical feature.


4. Scarring: The healing process frequently results in thick, rope-like scar tissue.

Next steps

• Consult a board-certified dermatologist who specializes in inflammatory skin diseases.


• Track your symptoms, triggers, and flare-ups using a journal or app to share with your care team.


• Join the hidradenitis suppurativa community at DiseaseMaps.org to connect with others who understand the day-to-day challenges of this condition.


• Ask your physician about the latest clinical trials or systemic therapies if standard treatments have not provided relief.

Medical disclaimer: This content is for informational purposes only and does not constitute professional medical advice, diagnosis, or treatment; always seek the advice of your physician or other qualified health provider with any questions regarding a medical condition.

References

• NIH Genetic and Rare Diseases Information Center (GARD): Hidradenitis Suppurativa overview.


• Orphanet: Portal for rare diseases and orphan drugs (ORPHA: 395).


• OMIM (Online Mendelian Inheritance in Man): Entry #142690 regarding familial cases.


• American Academy of Dermatology (AAD): Clinical guidelines for the management of Hidradenitis Suppurativa.