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Hidradenitis suppurativa

(pr. hide-ra-den-eye-tis sup-you-rah-tee-vah)

Hidradenitis Suppurativa (HS) is a chronic skin disease, which appears as a boil like abscess in the apocrine gland-bearing areas, such as the armpits, breasts and groin. This recurrent inflammatory, and often painful disease is often overlooked, as not much is known of the actual cause.

HS was first described in 1833 by the French anatomist and surgeon Alfred-Armand-Louis-Marie Velpeau, which is where the name Velpeau's Disease originates. It was later investigated by another French Surgeon called Artistide Auguste Stanislas Verneuil from 1854 to 1865, earning it the name Verneuil's Disease, and it was he who conducted the first clinical studies of HS.

Verneuil later renamed the disease Hidrosadenite Phlegmonous in 1864, which translates to the English Hidradenitis Suppurativa, meaning the inflammation of a sweat gland (Hidradenitis) containing or associated with pus (Suppurativa).

Diagnosis

Diagnosis of HS is made by looking at the 3 main characteristics of the disease:

Lesions - Are they deep-seated boil like nodules and/or fibrosis. Location - Armpit, groin, breast and/or buttocks. Relapses and Chronicity.

Some other questions would also need to be asked, such as:

Does anyone else in your family suffer from similar symptoms. Do the boils recur in the same place each time. Do they get worse during the premenstrual period.

Unfortunately, as this disease is not very well known, HS is quite often mistaken as common abscesses, boils, sexually transmitted diseases, skin infections or just in-growing hair follicles, to name but a few. This in turn can lead to a delay in appropriate referrals and diagnosis, and therefore may result in further advancement of the disease.

Stages of the condition

Doctors classify the disease into three distinct stages:

  • Stage 1 – single or a few isolated abscesses without scarring or sinus tracts.
  • Stage 2 – recurrent abscesses in more than one area and the beginning of the formation of sinus tracts.
  • Stage 3 – widespread abscesses with many interconnected sinus tracts under the skin. There may be severe scarring and continuous leaking.

HS persists for many years and there is no cure, but symptoms may be improved with treatment if it is diagnosed early. Not all people with HS progress to stage 3 – the disease can be controlled so it doesn't progress beyond stage 1.

However, HS can affect your life in many ways. Routinely changing dressings and living with the pain, discomfort and embarrassment of the symptoms can affect quality of life and lead to stress, anxiety and depression.

Some images of HS can be seen on the US National Library of Medicine National Institutes of Health Website.

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