Hidradenitis Suppurative (Acne Inversa)

What is Hidradenitis Suppurativa ?

The term “ Hidradentitis suppurativa (Acne inversa)” refers to a painful, long-term skin condition that causes abscesses and scarring on the skin. Hidradentitis suppurativa is also called Acne inversa, as acne-like lesions are seen on atypical places compared to normal acne. 

Why does Hidradenitis suppurativa occur ?

The precise pathogenesis of the disease is incompletely understood. There is a genetic predisposition and external risk factors that can trigger HS such as:

Uncontrollable Risk Factors

  • Age 
    •  after puberty
    •  average age of presentation early 20`s)
  •  Gender: female/male: 2 : 1

Controllable Risk Factors

  • Obesity 
    •  unhealthy Diet
  •  Smoking 
  •  Skin moisture
    •  Sweating  
    •  Try to minimise getting affected areas moist. Tampons may be better than sanitary pads for women
  •  Skin irritation or injury
    •  shaving affected areas  
    •   avoid using deodorants, antiperspirants, and perfumes
  •   Stress
  •  Androgens 
  •  ………

What Forms of Hidradenitis Suppurativa are there?

The Hurley staging system, which is commonly used for assessing HS severity distinguishes 3 degrees of severity: 

Stage 1 : Solitary or multiple isolated abscess formation without scarring or sinus tracts

Stage 2 : Recurrent abscesses, single or multiple widely separated lesions, with sinus tract formation

Stage 3 : Diffuse or broad involvement across a regional area with multiple interconnected sinus tracts and abscesses

What are the consequences of Skin tear wounds?

When skin tear wounds are not well identified, their treatment by an inexperienced treatment team results in:

  • Prolonged treatment duration with significant impairment of the patient
  • Poor treatment outcome
  • Increased complication rate, including permanent damage

How can you treat a Skin Tear wound ?

  • Avoid triggers for HS
  1. Obesity (→ reduce weight, stop unhealthy Diet)
  2. Smoking (→ reduce/stop smoking)
  3. Skin moisture 
    – Sweating (→ breathable cotton clothes) 

    – Try to minimise getting affected areas moist. Tampons may be better than sanitary pads for women
  4.  Skin irritation or injury
     – shaving affected areas (→ don`t shave) 

     -avoid using deodorants, antiperspirants, and perfumes,  if the underarms are (advise antiseptic wash to keep skin clean to reduce odor (e.g. Triclosan™) ) 
  5. Stress
  6. Androgens (→ „Pille“)
  • Mental Health Support (Soul Treatment)

 People with HS suffer from greater pain and associated psychological comorbidities, including depression, anxiety, disability, and impairments in quality of life (QoL), compared to those with other dermatologic conditions

  • Physical Health Support (Body treatment)
Depending on the Hurley stage, preventive, conservative (non-surgical) or surgical treatment methods are used

HS needs a multidisciplinary team approach