Hidradenitis suppurativa is a skin condition that presents with the formation of abscesses in specific areas of the body, which may be very painful and rupture to leak pus. The area usually heals with time, but the skin may be damaged and permanently marked with deep scars.

There are several stages of the disease, to categorized changes of progression as it spreads to other areas of the body and has more severe effects.

Signs and Symptoms

The signs and symptoms of hidradenitis suppurativa can vary greatly according to the individual case and the stage of the condition.

It usually begins with the appearance of a single pimple-like lump called an abscess. The lesion typically resolves spontaneously after 2-4 weeks and then another may appear some time later in the same region.

Over time, this can lead to more severe abscesses, which can be very painful and cause significant scarring to the skin as a result of the healing lesions. In some cases, the lumps can become infected with bacteria and cause a secondary infection.

This can be very distressing for patients, as there is a constant series of lesions appearing one after the other immediately after the previous ones heal. Channels under the skin can also form to create a network underneath the skin that will ooze pus if ruptured. Hidradenitis suppurativa is a chronic condition that requires constant management to maintain control over symptoms.  

Affected Areas

Hidradenitis suppurativa typically affects the area in specific areas of the body where skin touches skin, such as the:

• Groin
• Armpits
• Underneath breasts
• Anus
• Buttocks
• Inner thighs

It may also affect other areas of the body, particularly in later stages of the disease. For example, severe cases may the exhibit spread of the abscesses to the neck, waistband, legs, sides, back or face.

Stages

Hidradenitis suppurativa usually begins with the development of a small, single lesion in one region. This may resolve spontaneously within about a month, or it may rupture and leak pus.

Subsequent lumps typically appear in the surrounding region and the size of the new lumps may increase, particularly if the condition is not adequately managed. Narrow channels underneath the skin known as sinus tracts can also form, which ooze pus when ruptured.

As the progression of the disease is highly variable, a classification system is used to categorize the stage of disease. The stages are:

• Hurley stage 1: single or a few lesions with no evidence of scarring or sinus tracts.
• Hurley stage 2: recurrent abscesses in several different areas of the body, with the initial formation of sinus tracts.
• Hurley stage 3: many abscesses throughout the body and a network or sinus tracts under the skin, with evidence of scarring and pus leaking.

It is often useful to photograph lesions at diagnosis and at specific intervals over time to monitor the changes of the skin, which can help in the management of the condition.

Related Conditions

Sometimes Hidradenitis suppurativa can be mistaken for other similar health conditions, such as:

• Acne
• Folliculitis
• Sexually transmitted infections (e.g. herpes)

The main points of differentiation between these conditions are the areas of the body affected and the location specificity of Hidradenitis suppurativa. Patients tend to notice lesions in specific areas of the body, where skin is in contact with other skin, and they abscesses recur in these regions.

References

• https://www.aad.org/public/diseases/painful-skin-joints/hidradenitis-suppurativa
• http://patient.info/health/hidradenitis-suppurativa-leaflet
• http://dermnetnz.org/acne/hidradenitis-suppurativa.html
• http://www.nhs.uk/conditions/hidradenitis-suppurativa/Pages/Introduction.aspx

Written by

Yolanda Smith

Yolanda graduated with a Bachelor of Pharmacy at the University of South Australia and has experience working in both Australia and Italy. She is passionate about how medicine, diet and lifestyle affect our health and enjoys helping people understand this. In her spare time she loves to explore the world and learn about new cultures and languages.