Lecture Notes: Hidradenitis Suppurativa (HS)

Overview

• Also Known As: Acne Inversus
• Type: Chronic inflammatory skin condition
• Affected Areas: Areas with high concentrations of apocrine sweat glands (e.g., armpits)
• Onset: Typically during puberty
• Prevalence: ~4% in the general population

Risk Factors & Associated Factors

• Genetic Component: Family history, autosomal dominant trait
• Lifestyle Factors:
  • Overweight/obesity
  • Metabolic syndrome
  • Smoking
  • Female gender
• Hormonal Influence: Symptoms fluctuate with the menstrual cycle

Pathophysiology

• Initial Trigger: Defective hair follicle becomes blocked
• Process:
  • Blockage leads to inflammation
  • Follicle rupture and immune cell recruitment
  • Bacterial infection and drainage

Clinical Findings

• Commonly Affected Areas:
  • Axilla (armpits)
  • Groin
  • Perineal/perianal areas
  • Infra-mammary (under breasts)
• Triggers:
  • Menstruation
  • Stress
  • Excessive sweating
  • Weight gain
• Prodromal Symptoms (12-48 hours before lesions):
  • Pain, burning, itching
  • Hyperhidrosis (excessive sweating)

Skin Lesions Characteristics

• Nature: Recurrent inflammatory lesions
• Types:
  • Nodules
  • Abscesses (pus-filled)
  • Draining tracts
  • Scarring
• Duration: Lesions can last days to months

Diagnosis

• Criteria:
  • Types of lesions: nodules, abscesses, draining tracts
  • Location: intertriginous areas
  • Chronicity and recurrence

Treatment

• Lifestyle Modifications:
  • Weight loss
  • Smoking cessation
• Medications:
  • Topical antibiotics (e.g., clindamycin)
  • Systemic antibiotics (e.g., tetracyclines)
  • Hormone therapy: OCPs (oral contraceptive pills), anti-androgens

Conclusion

• Importance of lifestyle modifications as a primary step
• Consider topical/systemic antibiotics and hormonal therapy if necessary

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Note: Always consider seeking professional medical advice for diagnosis and treatment.