Hidradenitis Suppurativa

What is Hidradenitis Suppurativa?

Hidradenitis suppurativa is a long-term inflammatory disease that affects hair follicles. It causes painful lumps, boils, abscesses and sometimes tunnel-like tracts beneath the skin.

HS most commonly occurs in the armpits, groin, buttocks, inner thighs and under the breasts. The condition is not contagious and is a result of poor hygiene. Although the exact cause is not fully understood, blocked hair follicles and an abnormal immune response are believed to play a role.

Hidradenitis suppurativa often sets in after puberty, and before age 40 in most cases. It can persist for many years and can worsen over time if left untreated. Combined medical and surgical therapy can help manage the disease and prevent complications.

Stages of Hidradenitis Suppurativa

Although HS is usually classified by severity rather than distinct disease types, doctors commonly use the Hurley staging system. Take a look at the various stages of hidradenitis suppurativa below:

How Common is Hidradenitis Suppurativa in India?

The exact prevalence of hidradenitis suppurativa in India is not yet known, as large population-based studies are lacking. As per multiple studies, the prevalence of HS varies from 0.1% to 4% and is more common in women. Most available data comes from small hospital-based studies, suggesting that the condition may remain under-recognised or diagnosed late.

What are the Symptoms of Hidradenitis Suppurativa?

Hidradenitis suppurativa causes recurrent, painful lumps in areas where the skin rubs together, such as the underarms, groin, inner thighs, buttocks and beneath the breasts. Symptoms may begin with mild discomfort or a single lump and later progress to abscesses, draining wounds, tunnels beneath the skin and permanent scarring.

Some of the common early warning signs and advanced stage symptoms of hidradenitis suppurative are listed below:

Diseases Similar to Hidradenitis Suppurativa

Hidradenitis suppurativa may resemble other conditions that cause painful lumps, pustules or abscesses around hair follicles. Folliculitis and recurrent boils are two common conditions that may need to be distinguished from HS through examination, symptom history and, if infection is suspected, laboratory testing.

A brief comparison of these three conditions is given below for better understanding:

Hidradenitis Suppurativa Vs. Folliculitis Vs. Recurrent Boils

What Causes Hidradenitis Suppurativa?

Several factors and risk factors contribute to HS, which include:

What are the Complications of Hidradenitis Suppurativa?

Complications associated with untreated HS are:

• Permanent Scarring: Chronic inflammation scars skin tissue.

• Formation of Tunnels: Interconnected tracts beneath the skin may develop as a result of chronic illness.

• Anaemia: In severe or long-standing HS, ongoing inflammation, blood loss from draining lesions and reduced iron use in the body can lead to low haemoglobin levels (anaemia).

• Secondary Infection: Open lesions are prone to infection.

• Restricted Mobility: Movement may be restricted due to pain and scarring.

• Lymphoedema: Chronic inflammation can disrupt lymphatic outflow.

• Emotional Distress Anxiety: Depression and social isolation are very common.

• Chronic Pain: Persistent inflammation can lead to persistent pain.

• Skin Changes: The skin can become thickened or toughened over time.

• Risk of Rare Skin Cancer: The likelihood may be increased in areas affected by long-standing, severe illness.

When Should I See My Healthcare Provider?

You should seek medical advice if:

• Painful lumps recur frequently, particularly at the same site of the body.

• Symptoms last for weeks and lesions increase abnormally.

• Lesions release pus or blood with a foul odour

• Scarring starts to show up

• Pain due to inflammation causes difficulty in moving, making everyday tasks difficult.

• Signs of fever or infection demand urgent medical assessment

How is Hidradenitis Suppurativa Diagnosed?

Doctors usually diagnose hidradenitis suppurativa through the following methods:

How is Hidradenitis Suppurativa Managed or Treated?

Common measures to treat or manage HS are:

Your HS treatment depends on how severe your ailment is and on your specific health needs.

Hidradenitis Suppurativa and Related Health Conditions

HS is frequently seen with other health conditions. These include obesity, diabetes, metabolic syndrome, hypertension, polycystic ovarian syndrome (PCOS), inflammatory bowel disease and depression. Managing these issues might enhance overall health outcomes and support HS treatment.

Common Medicines Used to Treat Hidradenitis Suppurativa

Medicines for hidradenitis suppurativa help control inflammation, reduce painful lumps and prevent further abscesses, tunnels and scarring. Treatment depends on disease severity, affected areas, previous response and the patient’s overall health.

Common medications used to treat HS may include:

• Clindamycin: Topical clindamycin may reduce inflamed lumps and pustules in mild, localised hidradenitis suppurativa.

• Doxycycline: This oral medicine may be prescribed for widespread mild-to-moderate disease because of its antibacterial and anti-inflammatory effects.

• Clindamycin and Rifampicin: This oral combination may be considered for moderate-to-severe disease that has not improved adequately with tetracycline medicines.

• Triamcinolone Acetonide: This corticosteroid may be injected into selected painful, inflamed lumps to provide short-term relief from swelling and discomfort.

• Metformin: Metformin may be considered when hidradenitis suppurativa occurs with insulin resistance, type 2 diabetes or polycystic ovary syndrome (PCOS).

• Spironolactone: This hormonal medicine may help selected women whose flare-ups are associated with menstrual cycles or androgen-related symptoms.

• Adalimumab: This injectable biological medicine may reduce abscesses and inflammatory lumps in moderate-to-severe disease that has not responded to conventional treatment.

• Secukinumab: This injectable biological medicine may be considered for adults with moderate-to-severe active disease when standard systemic treatment has not provided adequate control.

• Paracetamol and Ibuprofen: These medicines may relieve pain during flare-ups but do not treat the underlying inflammation or prevent disease progression.

Note: The medicines listed above are commonly used to manage hidradenitis suppurativa. The treatment plan depends on disease severity, frequency of flare-ups, associated medical conditions and previous response to therapy. Never start, stop or change any medicine without consulting a qualified dermatologist.

Living With Hidradenitis Suppurativa: Daily Challenges and Patient Well-Being

Living with hidradenitis suppurativa may involve recurrent pain, wound care and long-term medical treatment. Draining lesions, scarring and unpredictable flare-ups can affect mobility, work, relationships and emotional health. Research has also found that greater disease severity is associated with a poorer quality of life.

Some of the daily challenges and essential care points for hidradenitis suppurative patients are mentioned below:

What is the Prognosis of Hidradenitis Suppurativa?

Hidradenitis suppurativa is generally not a curable disease. However, the long-term prognosis is favourable as it is possible to effectively manage the condition with early diagnosis, appropriate treatment and lifestyle modifications.

Many patients experience periods of remission where symptoms improve significantly. Treatment can help with flare-ups, discomfort and scarring, but the condition can relapse, which makes regular monitoring essential.

How Can I Prevent Hidradenitis Suppurativa?

Some effective measures to prevent HS are:

• Maintain a healthy weight, as this measure may reduce skin friction.

• Avoid smoking because it is a recognised risk factor.

• Wear loose clothes to reduce irritation.

• Avoid constant rubbing in affected areas.

• Control diabetes and metabolic conditions, as reducing inflammation can lead to improved overall health.

• Keep skin clean and dry to reduce the risks of getting HS.

• Seek early treatment to prevent HS progression.

• Ensure regular monitoring to support long-term disease control.

Hidradenitis Suppurativa Treatment Cost in India

The cost of hidradenitis suppurativa treatment in India depends on the severity of the disease, frequency of flare-ups, medicines prescribed, need for biologic therapy, surgical procedures and the treating hospital. Mild disease is often managed with medicines, wound care and lifestyle measures, whereas advanced disease may require repeated procedures or surgery.

An overview of approximate treatment expenses of hidradenitis suppurativa in India is given in the table below:

Disclaimer: The costs listed above are approximate and may vary depending on the city, hospital, dermatologist's consultation fees, disease severity, investigations required, treatment approach, brand of medicines or biologic therapy and the patient's overall medical condition. Actual expenses may differ between healthcare providers.

Does Health Insurance Cover Hidradenitis Suppurativa?

Yes, most comprehensive health insurance policies in India cover treatment for hidradenitis suppurativa if it is medically necessary and requires hospitalisation.

Coverage may include:

• Hospitalisation expenses

• Diagnostic investigations during hospitalisation

• Surgical procedures

• Daycare treatments (if applicable)

• Prescribed medications during hospitalisation

• Pre and post-hospitalisation expenses

Outpatient consultations, treatments, diagnostic tests and medicines can be covered if the policy has an OPD cover. If HS is deemed a pre-existing condition (it existed before policy purchase), there may be a waiting period of about 1-3 years, which varies based on the plan.

Note: Coverage details differ between plans, so reviewing policy wording carefully remains important.

How Much Health Insurance Coverage is Needed for Hidradenitis Suppurativa Treatment?

The amount of health insurance needed for hidradenitis suppurativa treatment depends on disease severity, treatment type, frequency of flare-ups and the city where treatment is received.

A health insurance coverage of around ₹5 to ₹10 lakh is usually adequate to cover HS consultations, diagnostics, medications, hospitalisation and minor surgical procedures.

Those with substantial wound treatment needs, recurrent surgeries, diabetes, obesity or a higher risk of complications may want to explore higher coverage of roughly ₹15 to 20 lakh. Make sure to review plans to determine the coverage that best meets your health needs.