Hidradenitis suppurativa – inflammation in the body folds

Hidradenitis suppurativa is an acne-like inflammation of the skin in the body folds, especially the armpits and groin. Sometimes it can also occur under or between the breasts, near the genitals, the area around the anus and the buttocks. It usually starts during or after puberty and is more common in women than in men.

Hidradenitis is a condition that can be accompanied by painful inflammation. At first, the inflammation looks like a small boil. Later they become larger and deeper and can burst open. This is often accompanied by pus and sebum discharge. In the long term, many inflammations can also cause tunnels in the skin (fistulas). In those corridors, the inflammation persists to a mild degree and can flare up again at any time. Large comedones (blackheads) and cysts (cavities in the skin) can also develop. When the skin heals again, scars may remain.

What is the cause?

Hidradenitis suppurativa is an inflammation of the hair follicles. There is a sebaceous gland in the skin of a hair follicle. By closing the exit of the hair follicles, the sebum that is produced by the body as standard cannot leave the follicle. This will initially accumulate innocently (blackhead). If too much sebum is produced, the pressure increases and the skin becomes inflamed with the addition of bacteria.

There are several factors that play a role in the onset and worsening of the condition:

• Smoking
• Overweight
• Heredity
• Hobbies – cycling, horseback riding
• Mechanical stress (pinching clothing, abrasive clothing)
• There is an association with Crohn’s disease, diabetes and (rheumatoid arthritis)

Is it contagious?

No, hidradenitis suppurativa is not contagious.

Self-care advice:

• Stop smoking (thereby less blackheads are produced)
• Shaving the armpits, groin, or using deodorant or washing with soap has not been shown to make HS worse
• Lose weight to minimize excess weight. This also reduces skin-to-skin friction in the folds and armpits
• Good hygiene
• Hibiscrub or Betadine scrub for inflammation (folliculitis)
• Do not wear tight clothing
• In case of complaints, consult a doctor or dermatologist

What can the skin therapist do for you?

In addition to medicinal treatment, the skin therapist can offer (additional) treatments.

• Laser therapy: By removing hair with the laser, blockage of the hair follicle is less likely to occur and the risk of inflammation is reduced. Unfortunately, this does not work for all patients. The success rate is about 50%.
• Chemical peeling: A chemical peel opens the exit of the hair follicle, dissolves sebum and inhibits inflammation.

What can the doctor do for you?

Hidradenitis is often a chronic condition. By giving up smoking and losing weight if you are overweight, complaints can improve, but unfortunately this does not work for everyone.

The doctor can prescribe creams that have a peeling effect, leaving the hair follicles’ exit passages open. In case of inflammation, antibiotic cream or tablets can be prescribed. If inflammation always returns to the same place, this is often due to the formation of tunnels (sinuses). By means of an operation, under anesthesia, the corridor can be opened or sometimes that spot can be removed, so that the inflammation does not return.

Hurley classification is a classification of the extension of hydradenitis suppurativa, from a surgical point of view.

Grade I: Formation of an abscess(es), single or multiple, without fistula formation and without scarring. Surgery not always necessary.

Grade II: Recurrent abscesses, single or multiple, with fistulizing and scarring, widely spaced (with normal skin in between). Surgery makes sense

Grade III: Contiguous (diffuse) or nearly contiguous lesions, or multiple interconnected fistulas and abscess cavities throughout the area. Operation makes sense, often major defects.

Several studies have shown that hidradenitis suppurativa responds well to treatment with TNF-blocking biologicals. The first experiences were with infliximab (Remicade, Remsima, Inflectra), but adalimumab (Humira) was also found to be effective.

In hidradenitis suppurativa, shame often also occurs. The inflammation and blackheads are unsightly, painful and can affect your social and sexual life. Don’t keep walking around with this, but discuss this with your doctor. We have many different treatment options to treat your skin and prevent painful inflammation.

While you are here

Acne vulgaris is the medical term for pimples (with adolescents). There is no other skin condition more famous than acne. It mainly occurs during puberty in both males and females. The 2010 Global Burden of Disease Study found that acne vulgaris is the eight most common skin disease, with an estimated global prevalence (for all ages) of 9.38%.

It is often said that after puberty you will no longer get acne. The following figures have been published from an acne study among 1,013 men and women aged 20 and older:

• 20-29 years: 50.9% (women) versus 42.5% (men)
• 30-39 years: 35.2% (women) vs. 20.1% (men)
• 40-49 years: 26.3% (women) vs. 12.0% (men)
• 50 years and older: 15.3% (women) vs. 7.3% (men)

Expanded on: acne, the different forms and what you can do.

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