Hidradenitis suppurativa (HS) is a skin disease that most commonly affects areas bearing apocrine sweat glands or sebaceous glands, such as the underarms, under the breasts, inner thighs, groin and buttocks.
The non-contagious disease manifests as clusters of chronic abscesses, epidermoid cysts, sebaceous cysts, pilonidal cyst or multilocalisedinfections, which can be as large as baseballs or as small as a pea. It can also start as a single abscess and once it pops, can make tracts of many more abscesses. These cysts can be extremely painful to the touch and may persist for years with occasional to frequent periods ofinflammation, culminating in incision and drainage of pus, often leaving open wounds that will not heal. For unknown reasons, people with hidradenitis develop plugging or clogging of their apocrine glands. HS causes chronic scarring and pus formation of the underarms (axilla) and groin/inner thigh areas. The simple procedure of incision and drainage provides some relief from severe, often debilitating, pressure and pain. Flare-ups may be triggered by perspiration, hormonal changes (such as monthly cycles in women), humidity and heat, and friction from clothing. Persistent lesions may lead to scarring and the formation of sinus tracts, or tunnels connecting the abscesses or infections under the skin. At this stage, complete healing is usually not possible, and progression varies from person to person, with some experiencing remission anywhere from months to years at a time, while others may worsen and require multiple surgeries in order to live comfortably. Wound dehiscence, a premature "bursting" open of a wound, often complicates the healing process. Occurrences of bacterial infections and cellulitis (deep tissue inflammation) may occur at these sites. Hidradenitis suppurativa pain and depression can be difficult to manage.
HS often goes undiagnosed for years because patients are too ashamed to speak with anyone. When patients see a physician or medical practitioner, the disease is frequently misdiagnosed or patients are prescribed ineffective treatments that can be temporary and sometimes even harmful. There is currently no known cure nor any consistently effective treatment. Carbon dioxide laser surgery is currently considered the last resort for those who have advanced to its highest stage, where the affected areas are excised, and the skin is grafted. Surgery does not always alleviate the condition, and may be very expensive.
Several articles and clinics consider this disease as widely misdiagnosed, due to the misunderstanding of the causes and progression of the disease. HS is not caused by poor hygiene. HS is often called an orphan illness due to little current research being conducted on the topic. Its incidence rate is not well established, but has been estimated as being between 1:24 (4.1%) and 1:600 (0.2%).