hey everyone so this doesn't is on hidradenitis suppurativa or HS so we're gonna talk about what this condition is in this lesson we're all sound talk about some of the signs and symptoms some of the triggers for this condition we're also gonna talk about how we can diagnose it and how we can treat it so hidradenitis suppurativa is also known as acne inversus it is a chronic inflammatory skin condition it can often look like this we're going to talk more about this later on in this lesson areas of the skin that are affected are often in areas where there are high concentrations of African sweat glands so African sweat glands can be found in places like the armpits the onset of this condition generally occurs during puberty and the prevalence in general population is about 4% so there are specific risks and associated factors with regards to hidradenitis suppurativa one of them is family history so it seems that there are genetic components to this condition there seems to be an autosomal dominant trait so if one of your parents has it you have a higher likelihood of having it as well being overweight or obese or having metabolic syndrome increases your risk for having this condition as well smoking smoking can actually increase your risk for getting this condition or increase the triggering of getting these skin lesions and being of the female gender as well and what we do find is that symptoms of hidradenitis suppurativa so these skin lesions seem to fluctuate with the menstrual cycle so there's some hormonal component with regards to this condition what is the pathophysiology of hidradenitis suppurativa so it all starts with a defective hair follicle so we talked about it's in areas with high concentrations of apocrine sweat glands and this defective hair follicle becomes blocked so you see here the hair becomes blocked many different epithelial cells and even bacteria get in here and start to cause inflammation and what happens is the follicle can rupture and can lead to surrounding inflammation you can have recruitment of immune cells so white blood cells can come into the area and then these cells can be released as well and you can have the bacteria being released and you can have drainage from the follicle so this is really a simplified look at the pathophysiology it all starts with a defective hair follicle that becomes blocked and eventually ruptures so what are some of the clinical findings in this condition intravenous areas are the most commonly affected what are inter Krajina s-- areas intra-regional areas are where skin meets skin so again the axilla or armpit s-- are one location the groin could be another location that perennial or peri anal areas and infra memory or underneath the breasts there are specific triggers of these skin lesions we talked about a couple of these menstruation seems to be one of them again the symptoms fluctuate with the menstrual cycle stress is also another trigger so having increased stress in one's life can increase the development of these skin lesions excessive sweating is another one so again it occurs a lot of times in the armpits so excessive sweating in those areas can actually increase the blocking of hair follicles and lead to more skin lesions weight gain is also another one this could be related to both hormonal but also having that increased surface area of more skin on skin contact now there are specific prodromal symptoms in affected areas that occur before the eruption of skin lesions so an individual who doesn't have the skin lesions in their armpits or in another part of their body yet can start to have issues with pain in those areas they can also have some burning itching as well can have hyperhidrosis or excessive sweating so the excessive said it could be a trigger but could also be a prodromal symptom a symptom that occurs before the individual has the development of the skin lesion and what we do find is that these symptoms the pain the burning the itching and the hyperhidrosis or the excessive sweating occur 12 to 48 hours prior to onset of the skin lesion so what are these skin lesions like well they are actually recurrent inflammatory skin lesions so they're recurrent in the sense that they can develop and then they can go away they can come back again with those triggers we talked about before they're inflammatory because of pathophysiology we talked about before the defective hair follicle becomes blocked and can rupture and cause local inflammation in the skin lesions themselves can be anything from nodules abscesses that are filled with pus draining tract so it's essentially where the pus and the fluid from the lesion has led to the skin and can allow that fluid to drain and there can also be scarring from this as well so all of these can be findings we see with this condition so you can see things like this so you can see both of these are in the axilla so we can see here here are some abscesses and possibly some sites of drainage can you see here around the gluteal area some spots where there may be some draining tracks as well and then here is another spot where it is very eroded and there's again more draining tracks that look like they have essentially ruptured so again there's skin lesions that are painful and have purulent drainage or grain pus and when you have these lesions when they occur they can last for days to months so they can last for a long time how do we make the diagnosis of this condition though how do we actually say this is hidradenitis suppurativa so the diagnosis involves if looking at a few different things we look at the skin lesions themselves are they non jewels are they abscesses and do they have draining tracts and not just that but the location of those lesions so we see that there are nodules abscesses or graining tracts and then we see them in inter krajina s-- areas so that is basically making us very suspicious that this is hidradenitis suppurativa and then when we look at the symptoms over time do these skin lesions relapse and are they chronic so are they recurrent do they develop in the armpits of an individual and then go away but then come back again with possibly one of those triggers we talked about before so looking at these three categories skin lesions the type of skin lesions the location of those lesions and then the symptoms over time if we have those three that very much helps us make the diagnosis of this condition when we've made the diagnosis how do we treat it so one of the first things that I always talk about with regards to treatment is lifestyle modification that's the first thing I always want you to think about if we can actually do that so what can we do with regards to lifestyle modification in hidradenitis suppurativa so one of the things we can do is weight loss so we talked about this before weight gain seems to be a trigger for the skin lesions in this condition and we also talked about being overweight obese and having metabolic syndrome is an associated risk for having hidradenitis suppurativa so perhaps losing weight will reduce your risk of having recurrent skin lesions from this condition so weight loss and smoking cessation are already great things so these can also possibly help you reduce your risk for getting these recurrent skin lesions in hidradenitis suppurativa some of the other treatments include topical antibiotics we often use clindamycin if they don't work we can move on to systemic antibiotics like tetracyclines and because there appears to be a hormonal interaction with hidradenitis suppurativa as we see it fluctuates with the menstrual cycle hormone therapy may be used as well so when I say hormone therapy here I mean OCPs or oral contraceptive pills sometimes you may see anti androgens being used as well but what I really want you to focus on is some of these lifestyle modification weight-loss smoking cessation and then we can move down the line if those don't work topical antibiotics systemic antibiotics and can move on to hormonal therapies like OCPs or oral contraceptive pills so I hope you found this lesson helpful and informative if you did please give it a thumbs up and consider subscribing to the channel and as always I hope you see next time and thank you so much for watching