Hidradenitis Suppurativa vs. Acne: How to Differentiate and Treat Chronic Inflammation

What is Hidradenitis?

Hidradenitis Suppurativa (HS) is a chronic inflammatory disease that affects the apocrine glands, located in specific areas of the body. These glands secrete a specialized fluid and are found only in certain regions, such as the armpits, groin, around the anus, genitals, buttocks, and under the breasts.

Due to skin folds in these areas, the apocrine glands experience a lack of oxygen, leading to secretion blockage and promoting the growth of pathogenic anaerobic bacteria. When apocrine glands become blocked and inflamed, they can form painful nodules and abscesses, which may merge and create tunnels under the skin.

What are Apocrine Glands?

Apocrine glands are special glands in your body that release fluid when you’re stressed or emotional. This fluid differs from regular sweat. Apocrine glands secrete a thicker fluid that is odourless but can develop a strong smell if bacteria get into it.

Apocrine glands respond to stress, emotions, and hormonal changes. They open into hair follicles, and if they become inflamed and rupture, the leaking fluid triggers an inflammatory process in the tissues, which can lead to all the previously mentioned issues.

Why is it Important to Know About HS?

HS can develop during hormonal changes, such as adolescence and puberty. This is a critical time when personal hygiene becomes more independent but requires special attention. Awareness of HS is important because the affected areas are often intimate, and teenagers may feel embarrassed to seek help from parents or professionals. As a result, the issue often goes unnoticed, leading to the progression of the disease and a significant decrease in quality of life. For those seeking comprehensive support, check these specialized facilities like https://residentialrehabilitation.co.uk/, can offer valuable resources.

The lesions that develop with HS are extremely painful and may discharge pus. Even after a flare-up subsides, the disease doesn’t go away, as it leaves deep scars and tunnels that can fill with pus again. Over time, the condition may worsen significantly, which heavily impacts both physical and emotional well-being, especially during periods of hormonal changes. Therefore, it’s crucial to be aware of this issue and know that there are treatments available that can greatly improve quality of life.

How to Distinguish HS from Acne and Other Skin Conditions?

HS can be difficult to distinguish from other skin conditions because its symptoms may resemble those of acne or boils. Here are some key differences:

Location: HS occurs in areas with apocrine glands (armpits, groin, around the anus, and genitals), whereas acne is more common on the face, back, and chest, and boils can appear anywhere. HS can also develop in less common areas, such as near the ear or around the navel. A few people have had HS on the face, neck, or back, but this is rare.
Chronic Nature: HS is chronic and often recurs, requiring long-term treatment, unlike more temporary acne.
Sinuses and Tunnels: HS is characterized by the formation of sinuses and tunnels under the skin, which is not typical for acne and boils.
Response to Treatment: Traditional acne treatments or antiseptics are less effective for HS, requiring specific interventions.
Hormones and Immunity: HS is linked to hormonal changes and autoimmune reactions, unlike acne and boils, which are associated with bacterial infections and skin care.

Main Signs and Symptoms of HS

The symptoms of HS vary depending on the stage of the disease:

Development of a Painful Nodule: Initially, a small, painful nodule appears, which can be tender to touch. It may resemble a regular acne but is more uncomfortable and painful.
Redness and Inflammation: Soon after, redness and inflammation start to develop around the nodule. The skin may feel warm to the touch and painful when touched, indicating active inflammation.
Formation of Pus: As the inflammation progresses, the nodule may begin to fill with pus. The pus can be thick, cloudy, or yellowish. At this stage, the nodule might resemble a common acne lesion, which may tempt one to squeeze it. However, squeezing can worsen the situation as it might spread the infection deeper into the skin.
Formation of Tunnels: If the inflammation continues, the pus-filled lesions can connect under the skin, forming painful and itchy tunnels or sinuses. These tunnels may be hidden from view and difficult to diagnose and treat, as they are located beneath the skin’s surface.
Scarring and Skin Thickening: After the inflammation subsides, scars may remain on the skin. These scars can be thickened and alter the skin’s texture. Over time, the scars may become more pronounced, affecting the skin’s appearance and functionality.

If you notice these symptoms, it’s important to consult a healthcare professional to prevent more serious complications and improve your quality of life.

Risk Factors and Predisposing Conditions

HS is a complex condition with causes that are not fully understood. Several factors can increase the likelihood of developing HS:

Genetic Predisposition: Family history plays a significant role in the development of HS. If close relatives have had or have HS, the risk of developing it is higher.
Hormonal Factors: Hormonal changes, especially during adolescence and the menstrual cycle, can contribute to HS. The disease often arises during hormonal fluctuations (puberty, pregnancy, menopause), which exacerbate inflammation and block apocrine glands. HS is more common in women.
Excess Weight and Obesity: People with excess weight are at a higher risk of developing HS. This may be related to increased sweating and friction in skin folds.
Smoking: Smoking cigarettes is associated with an increased risk of HS. Chemicals in tobacco smoke can worsen skin conditions and contribute to inflammation.
Metabolic Disorders: Some metabolic disorders, such as diabetes or polycystic ovary syndrome, can increase the risk of HS.
Chronic Autoimmune Diseases: People with chronic autoimmune conditions, such as Crohn’s disease or arthritis, may be more predisposed to HS.
Skin Infections and Damage: Recurrent infections, trauma, and skin irritations can contribute to the development of HS, as they can cause inflammation and block apocrine glands. HS is often associated with anaerobic bacteria, such as Cutibacterium acnes and Peptostreptococcus, which contribute to abscess and sinus formation.

How HS is Diagnosed

The diagnosis of HS is typically made clinically, meaning it is based on the patient’s history and a visual examination. It’s essential to find a specialist familiar with this condition. A dermatologist can usually recognize HS. The classification of HS into stages was proposed by Hurley in 1989. This system divides the disease into three stages based on the severity of symptoms and skin changes:

Stage I (Mild): Single or multiple inflamed nodules without abscess formation or scarring. The inflammation is localized, and there is no significant disruption of skin structure.
Stage II (Moderate): Recurrent nodules and abscesses that may connect through underground passages (sinuses), leading to scarring. Lesions are more extensive but do not merge completely.
Stage III (Severe): Multiple interconnected nodules, abscesses, and fistulas forming extensive areas of damage with numerous scars and sinuses. Inflammation is widespread, and the skin is significantly damaged.

Content Warning: This article contains images and descriptions of skin conditions that some readers may find distressing. Viewer discretion is advised (Click to see the image of HS stages)

HS Stages Pictures Download

Modern Treatment Methods for HS:

Lifestyle and Dietary Changes:
- Weight Loss: Losing 5-10% of body weight in cases of excess weight may reduce symptoms.
- Diet: A low-sugar diet and a Mediterranean diet are recommended to reduce inflammation. Avoiding dairy products, and gluten-containing foods, and identifying food intolerances may also be beneficial.
Conservative Treatment:
- Topical Antiseptics and Antibiotics: To control infection and reduce inflammation.
- NSAIDs: To relieve pain and inflammation.
Medications:
- Systemic Antibiotics: To combat severe infections.
- Corticosteroids: To control inflammation.
- Immunosuppressants and Biologic Agents: For severe cases of HS.
Supplements:
- Inclusion of Vitamins and Minerals: Such as vitamin D and zinc, which may help support the immune system and improve skin condition.
Surgical Treatment:
- Abscess Drainage: To remove pus.
- Surgical Removal: For severe and chronic forms of HS.
Innovative Methods:
- Laser Therapy: To remove inflamed tissues.
- Cryotherapy with Liquid Nitrogen: Cryotherapy using liquid nitrogen may be applied to treat HS tunnels. This method involves injecting liquid nitrogen into the tunnel with a needle.

How Lifestyle Changes Can Help:

Regular Cleaning: Keeping areas prone to inflammation clean can help prevent infections and flare-ups. However, it’s important to avoid aggressive methods like squeezing, which can worsen the situation.
Avoiding Triggers: Identifying and avoiding factors that trigger flare-ups (such as overheating, friction, and stress) can help manage symptoms.
Lymphatic System: Regular physical exercise can improve the function of the lymphatic system.
Smoking: Quitting smoking can help improve overall health and reduce inflammation.
Obesity, Tight Clothing, Smoking, Excessive Use of Deodorants, and Shaving: These factors increase the risk of developing HS.
Natural Fabrics: Wear breathable natural fabrics, such as cotton, to minimize friction and sweating in problematic areas.

Risk Groups:

People with Metabolic Disorders: Obesity and high blood sugar levels.
Smokers: Smoking exacerbates inflammatory processes.
Women: The condition is more common in women, especially between the ages of 20 and 40.
People with Autoimmune Diseases: HS often accompanies other inflammatory conditions, such as Crohn’s disease.
African Americans and Mixed Race: Studies show that African Americans have a higher risk of developing HS.

Complications of HS

Infectious Complications: The spread of infection from inflamed nodes and abscesses can lead to cellulitis, chronic fistula formation, and sepsis—a life-threatening condition where infection enters the bloodstream and causes systemic inflammation.
Physical Complications: Formation of scars, sinuses, and tunnels under the skin, which can lead to limited mobility in affected areas and chronic pain.
Increased Risk of Other Diseases: People with HS have a higher risk of cardiovascular disease and squamous cell carcinoma of the skin.
Psychological Complications: Chronic pain, scarring, and limited mobility can lead to depression, anxiety disorders, and reduced quality of life.

Important to Know:

HS is not contagious: It is not spread through contact or sexual means.
Timely Treatment is Essential: Without treatment, the condition can progress, causing abscesses and scarring, leading to complications, and even disability.
Diagnostic Challenges: Many patients may live with this condition for an average of 5 years without suspecting it due to the similarity of symptoms with other skin issues such as acne and boils.

Conclusion

Hidradenitis suppurativa (HS) is a chronic inflammatory condition that requires a comprehensive treatment approach. Modern methods include lifestyle modifications, medical treatments, and innovative procedures. Effective symptom management is possible with early medical intervention and adherence to recommendations such as quitting smoking, maintaining a healthy weight, and avoiding triggers. A visit to a dermatologist can expedite the diagnostic process and improve treatment outcomes. It is important to remember that HS is not contagious and requires a tailored approach to minimize complications and improve quality of life.

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