By Allen Douma, M.D
Published: July 11, 2004
© Chicago Tribune / Tribune Media Services


Q. One of our daughters has developed hidradenitis suppurativa, a relatively rare disease. We know that not much is known about the cause, or how to treat it well. We also know it to be debilitating.

--E.T., Salem, Ore.

A. It sounds like your knowledge of it being debilitating is from your experience with your daughter.

When someone has a severe case of this disease, it can cause a lot of psychological challenges on top of the physical ones. Hopefully the following will help guide better treatment.

Hidradenitis suppurativa is a poorly understood and frequently underreported chronic medical condition of inflammation in and around certain types of hair follicles. These hair follicles are located primarily in the groin, armpit and around the nipples.

Until recently it was thought that the primary problem was with the sweat (apocrine) glands. But a recent study has shown that the hair follicle itself is the primary problem, with the sweat gland being secondarily affected.

Another recent study also found that as many as 4 percent of people have hidradenitis to some degree, but it's usually not bad enough for them to undergo the cost and inconvenience of seeking medical attention.

Hidradenitis is more common in women. Although many women report that it flares up before menstruation, having hidradenitis is not related to levels of hormones. It occurs in many women after they reach menopause.

The most common symptoms are painful, tender, firm, nodular lesions under the arms. The nodules may open and drain pus spontaneously. Nodules will heal slowly, with or without drainage, over 10 to 30 days.

In typical cases, nodules recur several times yearly. In severe cases, the patient may suffer a continual recurrence of new lesions forming as soon as old lesions heal.

Many people think it is simply acne and treat it the same way. But the treatment for acne does not work for hidradenitis. Unfortunately, there is no great medical treatment for it.

There are some things your daughter can do that might help. Excessive heat, perspiration and obesity seem to aggravate the condition, so she should minimize heat exposure and sweating, and lose weight if overweight. A recent research study suggests that cigarette smoking could be a major triggering factor of hidradenitis suppurativa.

Oral antibiotics and steroids (both oral and injected) as well as rigorous skin cleaning and topical antibiotics may help some people. If nothing else, it may help prevent secondary bacterial infections.

Although it's commonly recommended that people with this condition not use deodorants or antiperspirants, studies have shown that they don't make much of a difference.

Topical products such as benzoyl peroxide may be helpful. Retin-A has helped some patients. Accutane can reduce the severity of attacks in some patients but is not a reliable cure for hidradenitis suppurativa.

Often people with severe cases are not adequately treated with medical management. For these people, surgical removal of the involved skin with skin grafting should be considered. Both surgical removal of skin flaps and "burning" each follicle with a laser have been shown to be safe and effective. The obvious downside of these treatments is that they do nothing for untreated areas.