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We attempt to dispell some of the myths about HS with an up to date article on it
What is Hidradenitis Suppurativa? - A factual Overview
Hidradenitis Suppurativa was first describe by the French doctor Velpeau in 1839.
"HS (also called Acne Inversa) is an inflammatory skin disease . . .
The main features of HS include painful, nodular and boil-like lesions,
scarring, sinus tracts [literally tunnels between boils] and recurrent
discharge, which have a significant impact on a patients quality of
life." [1].
Fig 1
Contrary to some sources HS is "A common disease with probably 100,000
suffers in the UK alone" [4] effecting an estimated 1.6% of the
population it has nearly a million suffers world wide [5], with 38% of
the population knowing someone who is effected by it [2]
Causes
This site has many articles that speculate on the cause of HS, this is
useful for research however in short "The cause of hidradenitis remains
unknown" [4]
Stages
There is widely regarded to be three stages in HS [7]
- Stage 1: Single or multiple abscesses formation, without sinus tracts and cicatrisation.
- Stage 2: Recurrent abscesses, with tract formation and cicatrisation. There may be single or multiple widely separated lesions
- Stage
3: Diffuse or near diffuse involvement or multiple interconnected
tracts and abscesses are obcserved across the entire area
Some Statistics about HS
The following statistics have been taken from the Journal of the
European Academy of Dermatology and Venereology in an article published
by the prolific and respected authour Jan von der Werth[2]. Some
statistics have been rounded up to two decimal places
General Observations about the illness
- The average age of onset is 22 years of age
- The illness tends to be at its severest in the first 6 years (however this does not include the influence of recall biases).
- The illness has an average disease duration of 18.8 years
- It affects women 2 till 5 times more than men [4]
- In women the illness is less common the older the patient gets, with some evidence to support menopause eases it [3]
- Occurrence of ‘lumps' can vary dramatically between one a year till 30 a month with an average of two a month
- Out of over 600 skin diseases suffers of HS have the highest rate of disability, though it is often concealed by paitents [4]
Occurrences
- The average boil lasts a week (7 days), equalling the
average course for antibiotics, which may explain why only 11% of
suffers feel they are helpful
- Factors that tend to worsen the
condition included sweating, heat and exercise (45%), Stress fatigue, feeling 'run
down', pressure, low self-esteem (35%), Summer time (32%), tight
clothing (16%), deodorants, cosmetics, scented toiletries and shaving
(13%), Menstruation (5%, but reflecting an alarming 44% of the female population) but 14% have no idea what affects their condition.
- 49% feel that medical
treatments help, with 19% stating various medical rememdies, 18%
stating surgery but only 11% feeling antibiotics have any effect.
- Less than half (40%
) benefit from change in lifestyle, with 15% with
bathing/showering/swimming, 11% find lose
clothing/cleanliness/drying/cold helpful, 9% feel sunshine and fresh
air is the order of day, whilst only 2% have notice a change due to
weight loss and would you believe 2% state pregnancy (however this combined with the data on menstration is often used to support a hormonal link)
- 24%, nearly a quarter of suffers state that nothing that they are aware of helps the condition at all
Treatment
"Recurrent boils in axillae or groins should be regarded as hidradenitis until proven otherwise.
Acute flare-ups can be treated with a very short course of systemic
corticosteroid or intralesional steroids. Short courses of antibiotics
are generally useless in long standing HS.
Long-term management is difficult. Acitretin works well but needs to be
prescribed with great care, particularly in young women.
There is a right way and a wrong way of performing surgery for
hidradenitis patients. The right way is by wide excision with secondary
intention healing or split-skin grafting. The wrong way is by incision
or narrow excision with primary closure." [4]
Hidradenitis suppurativa or Acne Vulgaris
Like so many areas of academia terminology has a pivotal and arguably distracting place within the subject area.
The name Hidradenitis Suppurativa suggests it is a suppurativa
inflammation of the apocrine sweat glands. However medical academics
are viewing it more as an occlusion of (the total closure of normally
open) hair follicles comparable to acne vulgaris. It is not the
terminology per se that is unpalatable but the suggestion the terms convey.
"Reviewing the literature on this subject, we were astonished to find
that even articles that concluded that the entity represents a form of
follicular occlusion still referred to it as hidradenitis suppurativa."
[6]
Despite this research on this site we refer to the condition as
Hidradenitis Suppurativa, primarily as it is the most widely used term
for the illness and we want the research in the site to be as well
disseminated as possible.
References
[1] Hidradenitis Suppurative Foundation, Inc, About Hidradenitis
Suppurativa / Acne Inversa 2006 available from
http://www.hs-foundation.org/pdf/HSF_Info_Kit.pdf [Accessed 8th March
2006]
[2] JM von der Werth, HC Williams (2000), The natural history of
hidradenitis suppurativa, Journal of the European Academy of
Dermatology and Venereology 14 (5), 389-392.
doi:10.1046/j.1468-3083.2000.00087.x
[3] Mortimer PS, Dawber RPR, Gales M et al. Mediation of hidradenitis suppurativa by androgens. Br Med J 1986; 292: 245-248.
[4] Jan von der Werth, (2001) Hidradenitis suppurativa, Dermatology in
Practice, Volume 9, Number 3, 2001 ISN: 0262-5504 available from
http://www.hs-usa.org/pub/articles/2001_HS_VDW.pdf [Accessed 10 March
2006]
[5] Based on the CIA estimation of the UK population as at July 2006 of
60,609,153 available from
https://www.cia.gov/cia/publications/factbook/print/uk.html [Accessed
10 March 2006]
[6] Sellheyer and Krahl (2005) "'Hidradenitis suppurativa' is acne inversa! An appeal to
(finally) abandon a misnomer" International Journal of Dermatology 2005, 44, 535-540
[7] Revuz, J., Hidradenitis suppurativa Orphanet Encyclopedia March 2004 Available from http://www.orpha.net/data/patho/GB/uk-hidradenitis-suppurativa.pdf [Accessed 26-March-2007]
Acknowledgements
Image (fig 1) courtesy of norrisnuvo released for use in this site under a Attribution-NonCommercial-NoDerivs 2.5
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