What Is Hidradenitis Suppurativa (“Dog’s Breast” Disease)?
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that affects the hair follicles and apocrine sweat glands. It is characterized by painful nodules, abscesses, fistulas, and scar tissue formation. It most commonly occurs in the armpits, groin, buttocks, anogenital area, and under the breasts.
Definition & Key Features
- Medical Name: Hidradenitis Suppurativa
- Common Name: “Dog’s Breast Disease” in Turkish
- Disease Type: Chronic inflammatory dermatosis
- Etiology: Follicular occlusion leading to recurrent inflammation and abscess formation
Epidemiology
- Prevalence: Less than 1% worldwide
- Gender: More common in women
- Onset: Typically after puberty and during adulthood
- Risk Factors: Genetic predisposition, obesity, smoking, hormonal fluctuations
Pathogenesis
- Hair follicle blockage
- Accumulation of sebum and keratin
- Bacterial colonization and inflammation
- Formation of abscesses and sinus tracts
- Recurrent flare-ups cause expanding tissue damage
Clinical Presentation
Early Stage
- Painful, small red nodules
- Tender swelling beneath the skin
Advanced Stage
- Abscess formation with drainage
- Fistulas and sinus tracts
- Skin thickening and scarring
- Impaired movement and reduced quality of life
Commonly Affected Areas
- Armpits — most common
- Groin — second most affected
- Under the breasts — especially in women
- Anogenital region — frequent in advanced disease
- Buttocks and inner thighs — due to friction
Disease Staging (Hurley Classification)
- Hurley Stage I: Single or multiple nodules without scarring or sinus tracts
- Stage II: Recurrent abscesses with sinus and scarring formation
- Stage III: Extensive lesion involvement, interconnected tracts, widespread scarring
Risk Factors
- Genetic predisposition — often present in family history
- Smoking — a major inflammatory trigger
- Obesity — increases skin friction and inflammation
- Hormonal changes — particularly in women
- Metabolic conditions — such as diabetes or metabolic syndrome
Impact on Quality of Life
HS frequently leads to physical pain, restricted movement, psychological distress (anxiety, depression), social isolation, and problems at work or school.
Complications
- Secondary infections — due to chronic inflammation
- Thick scar tissue — can restrict movement
- Sinus tract formation — persistent tunnels under the skin
- Lymphedema — localized swelling due to lymph drainage disruption
- Psychological impact — chronic disease burden often affects mental health
Diagnosis
- Clinical Examination — primary diagnostic method
- Imaging:
- Ultrasound — visualizes tracts and abscesses
- MRI — evaluates extensive or deep lesions
- Lab Tests: No specific test, but general inflammation markers may be checked
Associated Conditions
- Inflammatory Bowel Disease (Crohn’s, Ulcerative colitis)
- Polycystic Ovary Syndrome (PCOS) — hormonal link
- Metabolic Syndrome — linked to insulin resistance and obesity
- Arthritis — due to chronic inflammation
Disease Course & Prognosis
HS may remain stable in some patients but progress rapidly in others. Early diagnosis and treatment improve outcomes.
Immunological & Molecular Basis
- Elevated pro-inflammatory cytokines (TNF‑α, IL‑1, IL‑17, IL‑23)
- Follicular hyperkeratinization leading to clogging
- Disruption of skin microbiome
- Genetic mutations (gamma-secretase, NOD2, PSTPIP1) implicated
Flare-Up Triggers
- Smoking — strongest single risk factor
- Obesity — increases friction-induced inflammation
- Stress — can worsen flares
- Hormonal changes — e.g., menstrual cycle
- Warm, humid environments — increase sweating and occlusion
- Poor hygiene — raises infection risk
Psychosocial Aspects
Common issues include depression, anxiety, isolation, loss of confidence, work difficulties, and limitations in daily life. Psychological support is often essential.
Long-Term Complications
- Squamous cell carcinoma — rare but increased risk in chronic sinus tracts
- Metabolic syndrome, cardiovascular disease, insulin resistance, hormonal disorders (e.g., PCOS)
Multidisciplinary Management
Effective HS management requires collaboration across specialties:
- Dermatology — diagnosis and topical/immunologic therapy
- Surgery — excision of advanced lesions and scarring
- Endocrinology — manages metabolic and hormonal components
- Psychiatry — integrates mental health support
- Physical therapy — helps maintain mobility
Recent Advances & Therapies
- Biological agents:
- Anti‑TNF drugs (Adalimumab, Infliximab)
- IL‑17 and IL‑23 inhibitors — emerging therapies
- JAK inhibitors — under clinical trial
- Other research areas: microbiome modulation, gene therapy, photodynamic therapy, laser interventions
Patient Self-Care Tips
| Recommendation | Description |
|---|---|
| Avoid friction | Avoid tight or synthetic clothing that chafes the skin |
| Gentle hygiene | Use soap-free, gentle cleansers |
| Weight management | Control obesity to reduce skin-fold inflammation |
| Smoking cessation | Crucial to reduce inflammation |
| Stress reduction | Psychological support or stress management practices |
Public Awareness & Education
Better awareness helps with early diagnosis, reduces stigma and shame, and encourages timely medical care and proper disease management.
Future Outlook
- Personalized treatment protocols
- Genetic component elucidation
- More precise immunological targeting
- New therapies under development hint at more effective long-term control
Conclusion:
Hidradenitis suppurativa is a chronic, complex, and systemic disease with far-reaching effects on patients’ lives. With early multidisciplinary intervention and patient engagement, quality of life can be significantly improved. Ongoing medical advances offer hope, but personalized care and monitoring remain essential.
⚠️ Disclaimer: This content is for informational purposes only and based on current scientific knowledge. If you experience symptoms, seek diagnosis, or require treatment, consult a qualified healthcare professional.
