Hidradenitis suppurativa (HS) | nidirect

Hidradenitis suppurativa (HS) is a painful, long-term skin condition. It causes abscesses and scarring on the skin. The exact cause of hidradenitis suppurativa is unknown. It occurs near hair follicles where there are sweat glands, usually around the groin, buttocks, breasts and armpits.

Symptoms of hidradenitis suppurativa

The symptoms of hidradenitis suppurativa range from mild to severe.

It causes a mixture of red boil-like lumps, blackheads, cysts, scarring and channels in the skin that leak pus.

The condition tends to start with a firm pea-sized lesion that develops in one place. This will either disappear or rupture and ooze pus after a few hours or days.

New lumps will then often develop in an area nearby.

If these aren’t controlled with medication, larger lumps may develop and spread.

Narrow channels called sinus tracts also form under the skin that break out on the surface and leak pus.

Hidradenitis suppurativa is very painful. The lumps develop on the skin in the following areas:

• around the groin and genitals
• in the armpits
• on the buttocks and around the anus (back passage)
• below the breasts

The abscesses may also spread to the nape of the neck, waistband and inner thighs. Other isolated areas that have been known to be affected include the front or back of the legs, the sides, the back area and even the face.

Some of the lumps may become infected with bacteria, causing a secondary infection that will need to be treated with antibiotics (see below).

Many people with hidradenitis suppurativa also develop a pilonidal sinus. This is a small hole or ’tunnel’ in the skin.

For reasons that are unclear, more women than men have the condition. It’s thought to affect about 1 per cent of the population.

Causes of hidradenitis suppurativa

The exact cause of hidradenitis suppurativa is unclear.   The lumps develop as a result of blocked hair follicles.

Smoking and obesity are both strongly associated with hidradenitis suppurativa.  If you’re obese and/or smoke, it’s likely to make your symptoms worse.

Hidradenitis suppurativa usually starts around puberty, but it can occur at any age. It’s less common before puberty and after the menopause. This may suggest that the sex hormones play a part.

Many people with the condition also have acne and hirsutism (excessive hair growth).

In rare cases, hidradenitis suppurativa may be linked to Crohn’s disease. This is particularly if it develops around the groin area and the skin near the anus.

Crohn’s disease is a long-term condition. It causes the lining of the digestive system to become inflamed.

Hidradenitis suppurativa runs in families in about a third of all cases. It’s not infectious and isn’t linked to poor hygiene.

Diagnosing hidradenitis suppurativa

There’s no definitive test to help diagnose hidradenitis suppurativa.

Your GP will examine the affected areas of skin.  They may take a swab of an infected area.

This can be helpful in making a diagnosis because the condition isn’t usually associated with the presence of bacteria that cause skin infections.

Hidradenitis suppurativa could potentially be mistaken for acne or folliculitis (inflammation of the hair follicles).

Treating hidradenitis suppurativa

Hidradenitis suppurativa is a lifelong, recurring condition. The condition requires constant management and is often difficult to manage.

It’s important to try to recognise and diagnose the condition in its early stages and prevent it getting worse.

Treatment for hidradenitis suppurativa will depend on your symptoms. In the early stages, it may be controlled with medication.

Surgery may be required in severe or persistent cases. Your GP will discuss treatment options with you.

Lifestyle advice

If you have hidradenitis suppurativa you should:

• lose any excess weight
• stop smoking, if you smoke
• use an antiseptic skin wash or antiseptic soap – this may be prescribed alongside other treatment (see above)
• hold a warm flannel on the lumps to encourage the pus to drain
• wear loose-fitting clothes
• avoid shaving affected skin and avoid wearing perfume or perfumed deodorants in the affected areas

Outlook

Although hidradenitis suppurativa can persist for many years, if it’s diagnosed early the symptoms can be improved with treatment.

The condition can have a significant impact on a person’s everyday life.

Having to regularly change dressings and constantly live with the pain, discomfort and embarrassment of the symptoms can affect your quality of life and lead to depression.

Speak to your GP if you’re having problems coping with the condition.

• Find out more about hidradenitis suppurativa on the NHS website

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Hidradenitis suppurativa (HS) – NHS

Hidradenitis suppurativa (HS) is a painful, long-term skin condition that causes skin abscesses and scarring on the skin.

The exact cause of hidradenitis suppurativa is unknown, but it occurs near hair follicles where there are sweat glands, usually around the groin, bottom, breasts and armpits.

For reasons that are unknown, more women than men have the condition. It’s thought to affect about 1 in 100 people.

Symptoms

The symptoms of hidradenitis suppurativa range from mild to severe.

It causes a mixture of boil-like lumps, blackheads, cysts, scarring and channels in the skin that leak pus.

Hidradenitis suppurativa can cause fleshy lumps to grow on the surface of the skin

Credit:

GIRAND/BSIP/SCIENCE PHOTO LIBRARY https://www.sciencephoto.com/media/668613/view

Sometimes, narrow channels (sinus tracts) form under the skin, which can break out on the surface and leak pus

Credit:

Alamy Stock Photo https://www.alamy.com/stock-photo-hidradenitis-suppurativa-52484079.html?pv=1&stamp=2&imageid=B6F62B10-1A6C-45D2-B395-4D3CF16D45CE&p=17774&n=0&orientation=0&pn=1&searchtype=0&IsFromSearch=1&srch=foo%3dbar%26st%3d0%26pn%3d1%26ps%3d100%26sortby%3d2%26resultview%3dsortbyPopular%26npgs%3d0%26qt%3dD1ARYB%26qt_raw%3dD1ARYB%26lic%3d3%26mr%3d0%26pr%3d0%26ot%3d0%26creative%3d%26ag%3d0%26hc%3d0%26pc%3d%26blackwhite%3d%26cutout%3d%26tbar%3d1%26et%3d0x000000000000000000000%26vp%3d0%26loc%3d0%26imgt%3d0%26dtfr%3d%26dtto%3d%26size%3d0xFF%26archive%3d1%26groupid%3d%26pseudoid%3d%7bA883FDE5-7F3D-4472-81F5-B61111916852%7d%26a%3d%26cdid%3d%26cdsrt%3d%26name%3d%26qn%3d%26apalib%3d%26apalic%3d%26lightbox%3d%26gname%3d%26gtype%3d%26xstx%3d0%26simid%3d%26saveQry%3d%26editorial%3d1%26nu%3d%26t%3d%26edoptin%3d%26customgeoip%3d%26cap%3d1%26cbstore%3d1%26vd%3d0%26lb%3d%26fi%3d2%26edrf%3d0%26ispremium%3d1%26flip%3d0%26pl%3d

The condition tends to start with blackheads, spots filled with pus and firm pea-sized lumps that develop in one place. The lumps will either disappear or rupture and leak pus after a few hours or days.

New lumps will then often develop in an area nearby. If these are not controlled with medicine, larger lumps may develop and spread. Narrow channels called sinus tracts also form under the skin that break out on the surface and leak pus.

Hidradenitis suppurativa can be very painful. The lumps develop on the skin in the following areas:

• around the groin and genitals
• in the armpits
• on the bottom and around the anus
• below the breasts

The lumps may also appear on the nape of the neck, waistband and inner thighs.

Some of the lumps may become infected with bacteria, causing a secondary infection that will need to be treated with antibiotics.

Many people with hidradenitis suppurativa also develop a pilonidal sinus, which is a small hole or “tunnel” in the skin at the top of the buttocks, where they divide (the cleft).

What causes hidradenitis suppurativa?

The exact cause of hidradenitis suppurativa is unknown, but the lumps develop as a result of blocked hair follicles.

Smoking and obesity are both strongly associated with hidradenitis suppurativa, and if you’re obese and/or smoke it will make your symptoms worse.

Hidradenitis suppurativa usually starts around puberty, but it can occur at any age after puberty. This may suggest that sex hormones play a part. Many people with the condition also have acne and excessive hair growth (hirsutism).

In rare cases, hidradenitis suppurativa may be linked to Crohn’s disease, particularly if it develops around the groin area and the skin near the anus. Crohn’s disease is a long-term condition that causes the lining of the digestive system to become inflamed.

Hidradenitis suppurativa runs in families in about 1 in 3 cases. It’s not infectious and isn’t linked to poor hygiene.

Diagnosing hidradenitis suppurativa

There’s no definitive test to help diagnose hidradenitis suppurativa.

A GP will examine the affected areas of skin, and they may take a swab of an infected area. This can be helpful in making a diagnosis because the condition is not usually associated with the presence of bacteria that cause skin infections.

Hidradenitis suppurativa could be mistaken for acne or ingrown hairs.

Treating hidradenitis suppurativa

Hidradenitis suppurativa is a lifelong, recurring condition that is often difficult to manage, although the symptoms may improve or eventually stop with treatment.

It’s important to recognise and diagnose the condition in its early stages to prevent it getting worse.

In the early stages, it may be controlled with medicine. Surgery may be required in severe or persistent cases.

Antibiotics

If you have lumps that are particularly painful, inflamed and oozing pus, you may be prescribed a 1- or 2-week course of antibiotics, if test show that you have a bacterial infection.

If bacterial infection is not present, low doses of antibiotics may be used to prevent inflammation. This longer course of antibiotics will last at least 3 months, to reduce the number of lumps that develop.

You may be given antibiotics as a cream (topical) or as a tablet, capsule or liquid. Antibiotic types can include lymecycline, doxycycline, erythromycin or clarithromycin.

In severe cases of hidradenitis suppurativa, a combination of clindamycin and rifampicin can be effective.

Antiseptics

Antiseptic washes, such as 4% chlorhexidine, applied daily to affected areas are often prescribed alongside other treatments.

Retinoids

Retinoids, such as acitretin, are vitamin-A based medicines that help some people with hidradenitis suppurativa.

Retinoids are always prescribed by dermatologists. They must be used with caution and cannot be taken during pregnancy. It’s also important to avoid getting pregnant for 3 years after stopping treatment, so they’re not usually prescribed if there’s a chance you could get pregnant.

Contraceptives

If hidradenitis suppurativa flares up before a period you may benefit from taking oral contraceptives.

Immunosuppressive treatments (infliximab and adalimumab)

In severe cases of hidradenitis suppurativa, treatments that suppress the immune system, such as adalimumab or infliximab, can be useful.

However, there are risks associated with suppressing the immune system, so they are usually only prescribed by a dermatologist if other treatments do not work.

Infliximab and adalimumab are immunosuppressive treatments that are given by injection at regular intervals either at home or in hospital.

Steroids

Rarely, you may be prescribed steroids, such as prednisolone, to reduce severely inflamed skin. Steroids can be taken as skin creams or tablets, or you may have an injection directly into affected skin.

Possible side effects of steroids include weight gain, poor sleep and mood swings.

Read more about steroid creams (topical corticosteroids), steroid tablets and steroid injections.

Surgery

Surgery may be considered in cases where hidradenitis suppurativa cannot be controlled with medicine.

Lifestyle advice

If you have hidradenitis suppurativa you should:

• lose weight if you are overweight
• stop smoking if you smoke
• use an antiseptic skin wash or antiseptic soap – this may be prescribed alongside other treatment
• hold a warm flannel on the lumps to encourage the pus to drain
• wear loose-fitting clothes
• avoid shaving affected skin

Outlook

Although hidradenitis suppurativa can persist for many years, if it’s diagnosed early the symptoms can be improved with treatment.

However, the condition can have a significant impact on a person’s everyday life. Having to regularly change dressings and constantly live with the pain and discomfort of the symptoms can affect your quality of life and lead to depression.

Speak to a GP if you’re finding it difficult to cope.

Page last reviewed: 17 March 2023
Next review due: 17 March 2026

90,000 causes, treatment and surgery? – Drink-Drink

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07 Jul, 2023

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10.02.2022 DrinkDrinkAdmin

Contents

• causes
• symptoms
• diagnostic
• Who and when to consult?
• Treatment: how to treat?
• Operation and drainage: in what cases?
• What if the abscess bursts on its own?

A lump that develops in the groin may be an abscess. This can cause pain and discomfort. Treatment varies depending on whether the puncture occurs naturally or not. Explanations and recommendations for care. Explanations with Dr. Philippe Goeb, General Practitioner.

What is an inguinal abscess?

An inguinal abscess develops in the groin, the part of the body located between the thigh and the trunk. “ Like any abscess, it is a collection of pus in the dermis (hair root, sweat gland, sebaceous gland), which in the course of its evolution gradually destroys the tissues surrounding it, explains Dr. Philippe Goeb, general practitioner. Inguinal abscess is caused by a localized infection and has symptoms of inflammation. Depending on the type of inguinal abscess and especially its location, treatment may include antibiotics or surgical treatment of the inguinal abscess. “.

causes

One poorly treated wound, mosquito pimple, scratched by hands and especially dirty nails , and the infection progresses to the point of abscess, forming a focus of yellowish, painful, pulsating pus.

symptoms

If the inguinal abscess is located superficially, it manifests itself lump of variable size, painful to the touch, also called a tumor. If it is deep, palpation increases pain near its location. Then the most common symptoms are as follows:

• localized pain
• Hot, red skin
• swelling of the skin
• Presence of pus within an abscess due to accumulation of microbes
• Sometimes fever

diagnostic

Often history and clinical examination are sufficient for the diagnosis of inguinal abscess. To determine the size or level of infection, the doctor may, if in doubt, ask:

• Ultrasound often, MRI, or scanner (rarely needed for superficial inguinal abscesses;
• puncture to take a sample;
• blood test.

Scheduled examinations also have the function of providing medical information necessary for possible surgery.

Who and when to consult?

In case of pain, or if the abscess does not disappear despite treatment with (wash the wound with soap and water, then apply antiseptic compresses), see a doctor, dermatologist, or even the emergency room for minor surgery.

Treatment: how to treat?

“Yes the abscess has been opened it is necessary that consult a doctor to avoid infectious complications which can become even more serious because the femoral artery passes nearby, warns Dr. Geb. Your doctor will drain this abscess to thoroughly clean and disinfect it. He may prescribe an antibiotic. “. Antibiotics are not necessary unless there are signs of infection. 85% of abscesses heal without antibiotic therapy. Systematic antibiotic therapy increases this cure rate to about 92% with less frequent relapses. “ But the rate of cure without antibiotics and the risk of antibiotic resistance justify not immediately prescribing an antibiotic to all patients. , says our expert.

Operation and drainage: in what cases?

Si the abscess does not open , it is recommended to evacuate the pus thanks to a surgical gesture that remains limited. It is done most often under local anesthesia, through an evacuation puncture, incision or surgery. To avoid recurrence, a doctor or surgeon will sometimes place a drain or absorbent wick that will evacuate any remaining pus. The wick should be changed every 48 hours by a doctor or nurse. Drug treatment completes intervention : This includes analgesics to control pain and fever, and antibiotics to control infection. If you experience pain, a feeling of heat, swelling, or a temperature rise above 38 °, tell the nurse or doctor who monitors the course of treatment.

What if the abscess bursts on its own?

Consult your physician to avoid taking unnecessary risks given the location of this abscess. In anticipation of an urgent consultation, clean around the abscess and apply a compress moistened with an antiseptic.

Thanks to Dr. Philippe Goeb, GP.

Food and Health

What is an abscess? Why open up? Can an abscess be treated at home?

When harmful bacteria enter the body, it responds with a universal defense reaction – inflammation. Under certain circumstances, inflammation can become purulent. Pus is formed – a thick liquid that contains a lot of protein, dead leukocytes and microbial cells. If enough pus accumulates in one place, an abscess occurs, or, in simple words, an abscess.

Abscesses can appear in any part of the body, even in the bones. Most often, they form under the skin, in the armpit, groin, genitals, anus, and in other places. There are ulcers under the mucous membrane (for example, on the gums, if a carious tooth is not treated for a long time, or a pharyngeal abscess – inflammation of fatty tissue behind the pharynx), in internal organs: in the liver, spleen, kidneys, lungs, etc.

Most often surgeons have to deal with subcutaneous abscesses. We will talk about their treatment below.

Can you manage an abscess on your own?

In principle, if the abscess is less than 1 cm in diameter and does not cause much concern, you can try to deal with it yourself. Warm compresses for 30 minutes 4 times a day help.

Under no circumstances should an abscess be squeezed out. By pressing on the cavity with pus, you create increased tension in it, which contributes to the spread of infection. You can not pierce the abscess with a needle. The sharp tip of the needle can damage the healthy tissue or blood vessel under the pus. Malicious microbes will not fail to take advantage of this opportunity and rush to develop new “territories”.

If something resembling an abscess has appeared on your skin, it is better not to hesitate with a visit to the surgeon. Especially if:

• the abscess is very large or there are several;
• you feel unwell, your body temperature has risen to 38°C or more;
• an ulcer appeared on the skin;
• a red line “went” across the skin from the abscess – this indicates that the infection has spread to the lymphatic vessel, and lymphangitis has developed.

Can an abscess be cured without opening?

Even the ancient Greek physician Hippocrates liked to say: “where there is an abscess, there is an incision”. Since then, little has changed in the principles of abscess treatment.

Why must an abscess be opened? The human body is arranged very wisely, usually it gets rid of everything superfluous. If pus has accumulated somewhere, this indicates that the natural mechanisms have been ineffective. The body does not know how to bring it out. At the same time, the cavity with pus becomes like a time bomb. Pathogenic microbes can spread beyond the abscess, sometimes this leads to severe complications, up to sepsis.

The best solution in this situation is to drain the pus through the incision. As a rule, after this, improvement quickly occurs, the healing process begins.

After opening the abscess, the surgeon may prescribe antibiotics, but not all patients need them.

How is an abscess opened?

The operation is usually performed under local anesthesia. You will practically not feel pain. The doctor will make an incision and clean the wound from pus – using a special suction, or manually, armed with a gauze napkin.

Once the wound has been cleaned, the surgeon will insert a finger or a surgical forceps into the wound to check for pockets filled with pus. Sometimes there are partitions inside the abscess that divide it into two, three or more “rooms”. All partitions must be destroyed and all pus must be released.

Wash the wound with an antiseptic solution. But they are not in a hurry to sew it in. Pus may accumulate under the stitches again. The cavity must be left open so that it cleans better and heals faster. To drain excess fluid, a drain is left in it – a strip of latex, one end of which is let out. Subsequently, dressings are carried out with antiseptic solutions, healing and antibacterial ointments.

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How quickly will the healing take place?

The further scenario of the development of events after the opening of the abscess usually looks like this:

• As a rule, immediately after the pus is released, the pain subsides and the general condition improves.