What is Hidradenitis Suppurativa?
Hidradenitis Suppurativa (HS) is a fairly common condition associated with dysfunction of the deep sweat glands (apocrine glands) in some of the most sensitive regions of the body. These include the armpits, the areas beneath the breasts, the groin and the buttocks. As much as 4% of the population in Canada may be affected.
What causes Hidradenitis Suppurativa?
The cause of HS may relate to a fragility of the ducts carrying sweat to the surface of the skin in those people who are affected. Rupture of these ducts results in local inflammation (red bumps and pimples) that can progress to form draining tunnels (sinus tracts) and even scars. Those who struggle with HS may suffer from local discomfort and the need to manage the purulent drainage and associated odor.
What are the common treatments for Hidradenitis Suppurativa?
· It is important to mitigate conditions that aggravate HS. Warm ambient temperatures and excessive activity are generally associated with increased sweating and these factors may worsen the condition. Loose clothing that wicks moisture away prevents the occlusion of the sweat glands which can be beneficial. Maintaining a healthy body weight can also help to reduce pore blockage in skin folds. Lower body fat will also reduce the need to dissipate heat by perspiring. Neuromodulators (eg. Botox) may also be injected locally to reduce sweating in areas such as the armpits. Some laser treatments may also reduce local hair ingrowth which can aggravate this condition.
· Smoking is felt to further weaken sweat ducts and may also worsen the inflammatory response. Smoking cessation is thus critical for HS patients.
· Antiseptic and antibiotic (eg. clindamycin) lotions applied topically to the affected skin may provide a benefit. Oral antibiotics (eg. tetracyclines) can also assist patients with HS.
· Certain medications that reduce hormone signaling to apocrine sweat glands (eg. some oral contraceptives and spironolactone) often provide a favorable impact for women affected with HS.
· Finally, surgery has traditionally been offered to patients with HS to remove or deroof chronic cysts. It can even be utilized to remove badly diseased skin or scarring in the affected areas.
New and innovative therapies for HS:
· More recently, so-called biologic medications have become available to treat patients with HS. Biologic therapies are usually injectable proteins formulated specifically to address the inflammation (redness, swelling and pus) that results from sweat gland rupture in HS patients. These therapies can be very effective! Two classes of biologics for HS include medicines targeting TNF-alfa (eg. adalimumab) and, more recently, IL-17 (eg. secukinumab and bimekizumab).
Research is essential to develop new HS medicines:
Fortunately, dedicated research is now developing even more tailored therapies. Such therapies bring the hope of achieving even higher efficacy while minimizing any undesirable effects.
Park Dermatology is committed to providing local patients with access to these more advanced therapies. Park Derm Research Institute is currently enrolling patients in a clinical trial that offers HS patients the opportunity to be treated with an emerging, innovative therapy developed specifically to target this disease.
If you suffer from hidradenitis suppurativa, please don't hesitate to contact our Research Coordinator, Emily (emily@parkdermatology.ca) to see if you qualify to participate at no cost to you.
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