Dr. Mark Kirchhof
Division Head of Dermatology, Faculty of Medicine, University of Ottawa & The Ottawa Hospital
Many Canadians are unaware of this skin condition and suffer in silence. Hear from a dermatologist about the importance of prompt diagnosis and treatment.
Hidradenitis Suppurativa (HS) is a chronic and often misdiagnosed inflammatory skin condition, characterized by painful and recurrent bumps in the folds of the skin, such as the armpits, breasts, groin, and buttocks areas.
Although the true prevalence is unknown, an estimated 1 million Canadians are living with HS. HS is more prevalent in women than in men, and it is commonly found in teenagers and young adults and people with African ethnicity. While the exact cause is unknown, research suggests that inflammation, sweat glands, hormones, and hair follicles play a major role, as can factors like obesity and smoking.i “There also appears to be a genetic component as about thirty to forty percent of patients have a family history,” says Dr. Mark Kirchhof, Division Head of Dermatology in the Faculty of Medicine at the University of Ottawa and The Ottawa Hospital.
Dispelling myths and misperceptions of HS
HS is considered a progressive disease in that it tends to worsen over time. It may start off as red, painful bumps the size of a pea under the skin. As the disease progresses, patients may experience deep recurrent abscesses that rupture and create tunnels under the skin which can express pus to the surface. These draining tunnels can be very painful and have severe quality of life impacts. “As you can imagine, having these painful lumps on the groin or buttock area makes it very hard to sit or move, so people might have trouble with things like going to school, going to work, or riding in a car or bus,” says Dr. Kirchhof. “With the ongoing pus discharge, patients may also have to wear absorptive padding, and sometimes the tunnels can become colonized with bacteria, giving off an unpleasant odour. All of this can affect one’s social relationships and psychological well being,” says Dr. Kirchhof.
Adding to the disease burden and stigma are myths and misperceptions that the disease is contagious or caused by poor personal hygiene. “As we’ve learned more about the disease, our knowledge has expanded, and we now know it’s strictly an inflammatory, auto-immune disease that is neither contagious nor caused by something the patient is doing,” says Dr. Kirchhof.
Timely diagnosis and treatment essential for optimal patient outcomes
Because HS is progressive, it’s essential that people who suspect they have this condition receive an accurate and timely diagnosis, as well as prompt management. There is currently no test for the disease, so diagnosis is made by clinical evaluation. “The recurrent nature is one of the hallmarks of the disease, so when diagnosing we look for those recurrent red bumps in the same location,” says Dr. Kirchhof.
While there is no cure for HS, there are many different treatment options. These range from topical therapies to antibiotics, biologics, injections with local steroids, hormonal therapy, retinoids, laser therapy and lifestyle changes. “In more severe cases, especially if patients have extensive scar tissue and major limitations to their mobility, surgery may be required,” says Dr. Kirchhof. The effectiveness of each of these therapies will depend on the individual, their stage of HS, and how their body responds to treatment.
Finding clinical guidance about HS
The fact that HS is a little-known condition can make it challenging to receive a correct diagnosis. In addition, patients may feel uncomfortable discussing their symptoms or seeking help from a dermatologist, and therefore delay getting diagnosed. If you are showing symptoms of HS, ask your doctor for a referral to a dermatologist to confirm diagnosis and learn which treatment options are best for you. “This is a difficult condition to treat, and patients have been suffering for a long time, but we work hard to reduce the impact of the disease, make patients’ lives easier, and provide hope,” says Dr. Kirchhof.
If you are showing HS symptoms, ask your dermatologist about potential treatment options, and visit hidradenitisandme.ca and hsfoundation.ca for more information.
This article was made with support from Novartis Canada.
MLR ID: 447643
