Keys to detecting hidradenitis suppurativa, a disabling and debilitating skin disease

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Due to its manifestations, it can have a strong negative impact on self-esteem and sexual life.

Hidradenitis suppurativa is the most disabling dermatological disease. Almost as common as psoriasis, it is estimated that more than 400,000 Argentines suffer it.

It is a chronic skin disease, characterized by pus-filled bumps or pimples in armpits, groin, genital region, buttocks, breasts. The lesions are often painful, suppurative, and smelly, and are located in intimate areas, which generates a great impact on the quality of life. He pain and drainage that wet the clothes they lead to limitations in work development and social life. The smell and involvement of the genitals can have strong negative consequences on self-esteem and sexual life. Therefore, the high proportion of these patients who suffer from anxiety or depression is not striking.

Of every 3 cases, 2 are women. The age of presentation is variable, but the usual is that the debut is from puberty and that it declines towards the 50 years. It affects approximately 1% of the population, but is frequently underdiagnosed.

In Argentina, according to a study carried out at the Hospital Italiano de Buenos Aires, the delay in diagnosis it can be up to 11 years. This delay in diagnosis is due to two factors: the delay in the consultation due to the modesty it generates in patients, and the lack of knowledge of the disease among the medical community.

When patients have an outbreak of the disease (for example, an abscess), they usually resort to an emergency ward, where they are attended by clinical doctors, surgeons or gynecologists, and they are usually diagnosed and treated as acute infectious processes with antibiotics and drains. At this point it is important to emphasize that hidradenitis suppurativa it is not an infectionbut rather a chronic inflammatory disease, and when suspected, patients should be referred to a dermatologist.

In this context, the pandemic only deepens the neglect of hidradenitis suppurativa, since the focus of health, both for patients and doctors, is on the prevention and treatment of the coronavirus, leaving aside this as so many other chronic pathologies.

In the case of hidradenitis suppurativa, the consequence of not treating the flare-ups involves the progression to more severe stages with fistulas (tunnels under the skin) and difficult to manage scars. And from the psychological point of view, the lack of diagnosis in a chronic and recurrent disease generates anguish and hopelessness in the patient, as they cannot name it and find an explanation for what is happening.

The disease begins with occlusion of hair follicles (holes where the hairs come out); This obstruction determines the formation of the “bumps” and generates a chronic inflammation of the skin. The causes are not fully known and are still under study, but there is a consensus that it is multifactorial in origin: there is a genetic predisposition (30–40% of patients have an affected first-degree relative) and predisposing factors such as smoking and obesity are involved.

Some of the keys to suspect hidradenitis suppurativa are:

If a patient believes that he or she has hidradenitis suppurativa, a see a dermatologist. Early diagnosis and prompt treatment is essential to avoid the potential progression to irreversible and debilitating injuries.

Treatments range from creams, through antibiotics and other oral medications, to injectable biological treatments, depending on the stage and other factors to take into account. On the other hand, in many cases it is also necessary to perform one or more surgeries. And beyond the specific treatments, the multidisciplinary approach to optimize psychological support, nutritional management, smoking and other associated diseases.

* Dra. Sabina Zimman Physician. Specialist in Internal Medicine and Dermatology (UBA). Coordinator of the Hidradenitis Suppurativa Section of the Hospital Italiano de Buenos Aires.

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