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Lori, 55, is an overweight diabetic who presents to the dermatologist with dozens of painful boils under her arms and groin which drains foul smelling pus.
Her body is covered in deep scars. She is embarrassed to try to date anyone because she is self-conscious of all the scars on her body.
As a result, she has become more depressed and started smoking a pack of cigarettes a day. It has taken a toll on her quality of life and emotional well-being of her by suffering with anxiety.
Recently, she went to the dermatologist and was diagnosed with an inflammatory skin condition called Hidradenitis suppurativa (HS).
To make matters worse, she found out that this is a chronic condition that can be exacerbated by smoking.
Susan’s previous three columns:
Know your skin:Don’t ignore strange spots on your skin; it could be deadly melanoma
It can happen to anyone:Child abuse can occur in all socioeconomic groups and races
Make your skin sing:Want your skin to look great this spring? Here’s what you should do
Nobody knows the exact cause of Hidradenitis suppurativa, but experts believe that it develops when hair follicles become blocked.
It’s important to know that Hidradenitis suppurativa is not caused by being unclean and it can’t be spread to others.
Hidradenitis suppurativa can be localized or generalized throughout the body, specifically armpits, breasts and the groin.
Signs and symptoms of the condition include:
- Painful small lumps the size of a pea.
- Leaking bumps.
- Tunnels or blackheads.
Some risk factors which may increase your chance of developing Hidradenitis suppurativa include:
- Age. Increased risk for those in their 20s and 30s.
- Sex. Females are more likely to develop than males.
- Race. In the United States, HS is significantly higher among African Americans.
- Family history. Can be inherited.
- Certain medical conditions increase risk such as diabetes, obesity, severe acne, arthritis and inflammatory bowel disease.
The key for effective treatment is getting an early diagnosis of Hidradenitis suppurativa. See your dermatologist if your condition:
- Becomes painful.
- Have difficulty moving.
- Doesn’t improve in a few weeks with antibiotics.
- Recourses within weeks of discontinuing treatment.
Persistent and severe Hidradenitis suppurativa can cause complications, including:
- infection. Presence of puss is common and doesn’t necessarily mean infection.
- Scars and skin changes which can be ropelike or pitted.
- Restricted movement. Limited or painful movement, especially when affecting the armpits or thighs.
- Skincancer. Squamous cell carcinoma has been reported with long-term Hidradenitis suppurativa, with involvement of the perianal area.
- Swelling in the arms, legs or genitals. Many of the most common sites for HS contain lots of lymph nodes. Scar tissue can block the lymph drainage system, which can result in swelling in the arms, legs or genitals.
- Psychological effects and social isolation.
Treatment options can vary depending on the severity of the injuries. For milder cases, a topical antibiotic can be effective treatment.
Some other ways that can improve the episodes are by changing to a healthy diet, losing weight and discontinuing smoking.
Oral antibiotics such as Doxycycline or Bactrim can be used to treat more moderate to severe HS over a few weeks to longer term such as a few months.
Corticosteroids can be prescribed as a pill or given as an injection to help reduce the pain and swelling.
Biologics such as Humira are very effective and can help put the HS into remission. Some patients hesitate on this treatment because they are scared of shots or are concerned that the immune system response maybe lowered.
As a last resort, the dermatologist may refer to a general surgeon for excision of the tracts, drainage, or de-roofing.
No matter which treatment you choose, don’t hesitate to make an appointment with your dermatologist.
Make sure to bring a friend or family member to help you learn about the condition and understand the benefits and possible side effects for the different treatment options.
Be proactive and get treatment early before the skin disease becomes out of control and causes more physical and emotional scarring.
Susan Hammerling-Hodgers, a Member of the National Psoriasis Foundation, is a PA-C (Certified Physician Assistant) and MPAS (Master of Physician Assistant Studies) and works at Brevard Skin and Cancer at the Merritt Island, Titusville and Rockledge offices.