Hidradenitis suppurativa

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

Hidradenitis Suppurativa (HS) is a chronic skin disease, which appears 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 of HS is made by looking at the 3 main characteristics of the disease:

Lesions - Are they deep-seated 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.

HS is graded into 3 stages, known as Hurleys clinical staging. The early stages of HS presents itself as a single, inflammed, boil-like nodule. These will either slowly disappear, or persist to become a suppurative (draining) absess, eventually degrading and scarring the affected area.

The later stages of the disease will see the affected areas spreading, with either single or multiple lesions with the formation of sinus tracts, or fistulas, where lesions drain from 1 or more location. These sinus tracts can interlink and become more widespread in stage 3. There is no guarantee that patients will progress to stage 3, as some do not progress further than stage 1. Some images of HS can be seen on the Johns Hopkins University Dermatology Image Atlas.

A short video describing HS can be viewed here. Video 1, Video 2.