What is hidradenitis suppurativa?
Hidradenitis (or hidradenitis) suppurativa (HS) is one chronic inflammatory disease in which they appear recurrent outbreaks of :
that produce pain, suppuration, itching and/or bad smell, especially in areas of folds, such as armpits, the groin, the glutes, the genitals or the region submammary.
A prevalence in the general population is estimated at around 0,7 - 1,2%, being three times more frequent in women, although in men the disease is usually more serious.
L'the origin of HS is unknown, although it has been associated with several factors, both genetic com environmental; therefore, it is a disease of origin multifactorial. These factors cause the hair follicles associated with the apocrine glands to become clogged and release a cascade of pro-inflammatory cytokines that end up irreversibly destroying the tissues over time.
Its complexity and chronicity have a negative impact on the quality of life of the patients, with psychological and social consequences, highlighting anxiety, depression, social isolation and low self-esteem.
Triggering or aggravating factors
- Tobacco. The odds of having HS are greater among active smokers compared to non-smokers or ex-smokers. In addition, active smoking is associated with more severe disease.
- Overweight and obesity. It is considered an aggravating factor rather than a trigger, due to the stimulus in the overproduction of pro-inflammatory factors, mechanical irritation, occlusion and maceration.
- friction. Shear forces and friction stimulate the appearance of lesions.
- other. Antiperspirant deodorants or some forms of hair removal such as shaving, cream or wax can contribute to follicular plugging, acting as aggravators of the disease.
Links of interest
Hidradenitis suppurativa is considered a systemic inflammatory disease.
An association has been shown with other diseases such as:
- Inflammatory bowel disease. The estimated prevalence of HS in patients with Crohn's disease is 12,4 - 17,9%. On the other hand, the presence of HS in patients with inflammatory bowel disease is associated with an earlier diagnosis, with a higher probability of requiring biological therapy and surgical treatment.
- Autoinflammatory and rheumatological diseases. HS is associated with a higher prevalence than in the general population to rheumatological diseases such as spondyloarthritis and sometimes forms part of complex syndromes caused by abnormal activation of the innate immune system: PASH (pyoderma gangrenosum, acne and HS) syndromes, PAPASH (pyogenic arthritis, pyoderma gangrenosum, acne), PsAPASH (psoriatic arthritis, pyoderma gangrenosum, acne and HS), PASS (pyoderma gangrenosum, acne conglobata, HS and axial spondyloarthropathy) or the SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis).
- Skin infections. Follicular obstruction causes inflammation and rupture of hair follicles with wounding and destruction of the inflamed tissue, which sometimes leads to superinfections caused by bacteria that may require systemic treatments.
- Metabolic syndrome. HS is associated with metabolic syndrome in up to 9,64% of cases, being twice as high as in the general population.
- Mental health. 60% of HS patients experience a high impact on their quality of life. In fact, the HS is among the five dermatological diseases that have the greatest impact on patients' quality of life.
Diagnostics and complementary scans
The diagnosis of HS is clinical. In case of diagnostic doubt or if we want to rule out any of its comorbidities and/or complications, it may be useful to perform:
- Biopsy and culture: in case of diagnostic doubt. It allows the differential diagnosis with other inflammatory diseases of the skin.
- Colonoscopy with biopsy: in cases with severe perianal involvement accompanied by digestive symptoms. It allows to rule out an associated inflammatory bowel disease.
- Genetic study: in familial or syndromic cases. It allows to rule out autoinflammatory syndromes that associate HS, or overlapping genetic diseases such as Dowling-Degos disease.
- Ultrasound of soft parts: makes it possible to properly identify skin lesions (nodules, abscesses, fistulas, scars) and the degree of inflammation they present. It can be useful as a pre-surgical as well as intra-operative planning tool.
In the monographic consultation of hidradenitis suppurativa of the Dermatology Service we have an ultrasound which helps us to correctly stage patients based on the counting of inflammatory lesions.
- Nuclear magnetic resonance (NMR) of soft parts: useful for pre-surgical evaluation, especially in the case of gluteal fistulas when we want to know if the anal sphincter is affected.
- Sacroiliac MRI: is the gold standard to rule out axial spondyloartopathy in the case of clinical suspicion.
- Blood analysis: acute phase reactants allow the degree of systemic inflammation to be monitored. In case of joint involvement it will be useful: HLAB27, glomerular sedimentation rate, C-reactive protein and antinuclear antibodies.
Combined treatment: medical and surgical
The treatment of HS is complex and varies depending on the severity of the disease and the characteristics of each patient. The complexity of this management requires a multidisciplinary approach involving different specialists.
- Treatments aimed at addressing the blockage of hair growth: retinoids.
- Treatments aimed at controlling the inflammatory response such as sulfone, corticosteroids or antibiotics. In refractory cases, the usefulness of biological drugs such as Adalimumab or others has been demonstrated.
- Other treatments: contraceptives and antidiabetics.
Surgical treatment in combination with medical treatment
In specific cases, it is chosen to combine surgical and medical treatments:
- Incision and drainage of abscesses relieves symptoms associated with acute inflammation, especially pain.
- Excision of the affected anatomical areas may be necessary to resolve existing inflamed lesions and prevent the appearance of new lesions.
- Other times, the wounds are left open for a variable time and wait for progressive healing (technique of the deroofing).
Clinical Medical and Surgical Commission for patients with hidradenitis suppurativa
The Medical and Surgical Clinical Commission for patients with hidradenitis suppurativa of Parc Taulí has been created following the prevalence of this systemic inflammatory chronic disease. Is multidisciplinary and plans and optimizes the therapeutic management of these patients. It meets bimonthly.
Some members of the Medical and Surgical Clinical Commission for patients with hidradenitis suppurativa
Patricia Garbayo Salmons - Coordinator of the Medical and Surgical Clinical Commission for patients with hidradenitis suppurativa
- Patricia Garbayo Salmons
General and Digestive Surgery
- Anna Pallisera Llovera
- Albert Garcia Nalda
- Anna Serracant Barrera
Plastic Surgery (Consorci Sanitari Terrassa)
- Josep Prat Escayola
- Cristina Ferrer de la Fuente
- Eva Van den Eynde Otero
- Silvia Capilla Rubio
- Albert Villoria Ferrer
- Mireia Moreno Martínez-Losa
- Marta Arévalo Salaet
- Sidharta Acebillo Baqué
- Jorge del Estal Jimenez
- Javier Delgado Rodríguez
- Raquel Pérez Hita
- Improve the diagnosis of HS in our reference area
- Spread the knowledge of HS among professionals in our hospital and in our primary care area to detect patients with HS early and avoid the progression of the disease to more advanced stages.
- Facilitate communication between the specialists who receive patients with HS and establish a more fluid circuit that allows to reduce the waiting times between medical visits and surgeries.
- Improve the handling of HS
- Create a clinical practice guide agreed between the different professionals of the Commission.
- Establish individualized treatment and follow-up for patients with HS.
- Early detection and treatment of associated diseases and HS complications.
- Avoid unnecessary visits to the emergency services as well as surgeries resulting from poor control of the disease.
- Promote continuing education about HS through clinical sessions.
- Increase the number of communications at the events of the Spanish and European HS Societies.