Hidradenitis Suppurativa
Introduction
Hidradenitis suppurativa (huh-dra-duh-nai-tuhs soo-puh-ruh-tai-vuh) is a skin condition which leads to painful lumps underneath the skin and usually affects the underarms, groin, buttocks or under the breasts. These can sometimes contain blood, fluid or pus and are prone to breaking open and can lead to scarring.
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Teenager boy with abscesses, comedones and scarring from hidradenitis suppurativa on buttocks
Who gets it?
About 1 in 100 young people suffer from hidradenitis suppurativa with girls being more affected than boys (2:1). Often it starts during puberty but can occur at any age. Sometimes people who suffer from acne or excessive hair growth (hirsutism) can get this condition.
What causes it?
The cause of hidradenitis suppurativa is not well understood, however it is believed to start when a hair follicle is blocked. This blockage leads to inflammation, which causes painful bumps on the skin surface. This usually occurs in areas where there are large numbers of sweat glands (armpit and groin). Sometimes this can cause infections which lead to formation of pockets that fill with pus. Risk factors include:
Smoking
Excess weight
Family history
Certain medical condtions such as diabetes, polycystic ovarian syndrome, high blood pressure and cholesterol
Certain medications such as lithium, sirolimus and biologic medications
What does it look and feel like?
Looks like…
Raised red or skin coloured boils under the skin
Tunnels underneath the skin called sinuses
Tunnels that connect with the skin call fistulas
Thick ropey red or skin coloured scarring
Blackheads like dots that usually occur in pairs
Feels like…
It can be very painful when a boil is particularly inflammed - some children complain of difficulty sitting and discomfort with wearing underwear or clothing. The pain gets better once the boil discharges or settles down.
It is occasionally itchy.
The skin can be raised and lumpy due to the boils or from scarring.
Sometimes the skin can feel warm due to boils becoming inflammed.
What tests might be needed?
Usually, no tests are needed to diagnose hidradenitis suppurativa. Your child's dermatologist will usually examine the areas affected.
What treatments are available?
What can I do?
Lifestyle changes
If your teenager is a smoker then it is important they stop smoking to help improve their condition .
In children who are overweight, achieving a healthy weight often reduces the severity of the condition.
Stress is known to play a role.
Help your child select clothing that is loose fitting, and avoid friction and rubbing from tight-fitting underwear and garments.
Medical therapies
Wash with antiseptics, bleach baths or antibacterial washes
Topical antibiotics
Steroid injections - this is helpful to spot treat any lumps when they cause severe pain
Antibiotic tablets (doxycycline, minocycline, clindamycin or rifampicin). These are usually used to reduce inflammation and not for bacterial infections.
Oral steroids - used for short period to help control flare ups
Pain relief
Biologic therapy - the latest treatment with promising results
Surgery - only reserved for selected group of patients
Laser - both for hair removal as well as treatment of some inflammation
Traditionally this condtion was treated as an infection and many children were given a short course of antibiotics and treated with surgery to remove or release the contents of the boils. This can result in unnecessary surgical scars without appropriately controlling the condition. It is now proven that hidradenitis suppurativa is an inflammatory process and NOT an infection. Unfortunately surgery is still performed by many doctors who may not be aware of this condition or aware that there are good medical therapies available to treat it.
Novel medical therapies are being investigated and developed. It is best to speak with your child's dermatologist about treatment options that are available to children with hidradenitis suppurativa.
What happens after treatment?
Hidradenitis suppurativa is often lifelong, recurs and requires ongoing management. It is sometimes difficult to manage but it is important to seek help early to minimise scarring and avoid inappropriate surgery.
What support is available?
Your GP and dermatologist will work hand-in-hand to manage your child's hidradenitis suppurativa. This condition can sometimes make people feel embarrassed or self-conscious due to difficulty controlling symptoms.
More infromation can be found on https://www.hs-online.com.au/about-hs-online.html https://www.hs-foundation.org/
Authors/Reviewers:
Author: Dr Beverly Manago
Paediatric Reviewer: Dr Mayuri Sivagnanam
Editor in Chief: Dr Tevi Wain
