What is: Hidradenitis suppurativa. INDEX
https://www.mayoclinic.org/diseases-conditions/
hidradenitis-suppurativa/symptoms-causes/syc-20352306
by Anonymous, 2020 for Mayo Clinic.
Updated: 2023-06-06

LINK 2: Hidradenitis suppurativa.
https://www.dermnetnz.org/topics/hidradenitis-suppurativa-guidelines/
Author: Vanessa Ngan, Staff Writer;
Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand. 1997.
Updated December 2015 REVISED
Authors: Saxon D Smith, Geoffrey Cains, Pablo Fernández-Peñas, Peter Foley, Dr John Frew, Kurt Gebauer6,
Gillian Marshman, Dr Erin McMeniman, Amanda Oakley, Dr Diana Rubel, Dr Helen Saunders, Dr Lynda Spelman
August 2018 --- 53 References included.

LINK 3: Hidradenitis suppurativa.
https://en.wikipedia.org/wiki/Hidradenitis_suppurativa
Authored by many volunteers; includes 58 References.
2017-06-17

LINK 4: Hidradenitis Suppurativa Diet.
https://www.healthline.com/health/hidradenitis-suppurativa-diet
Written by Jillian Kubala, MS, RD
May 2, 2018

LINK 5: Treating Your Hidradenitis Suppurativa at Home.
https://www.healthline.com/health/hidradenitis-suppurativa-remedies
Written by Ana Gotter
Medically reviewed by Nancy Carteron, MD, FACR
January 25, 2019

LINK 6: Hidradenitis suppurativa.
https://doi.org/10.1038/s41572-020-0149-1
by Robert Sabat, Gregor B. E. Jemec, Lukasz Matusiak,
Alexa B. Kimball, Errol Prens & Kerstin Wolk
(Available by Rent, Buy, or Subscribe options)
2020-03-12 --- (includes 233 references)

LINK 7: Hidradenitis Suppurativa.
https://www.webmd.com/skin-problems-and-treatments/hidradenitis-suppurativa
Complications can include cancers, arthritis, depression.
Myths: discounting past assumptions and beliefs.
Reviewed by Debra Jaliman, MD
February 03, 2020
Updated: September 17, 2023
Written by Katherine Kam
Medically Reviewed by Poonam Sachdev

INDEX F (FACTORS) Index

INFLUENCES - Triggers.
• Hidradenitis: Dairy / Milk.
• Hidradenitis: Refined Sugars.
• Hidradenitis: Brewer's Yeast.
• Hidradenitis: Nightshade plants.
• Hidradenitis: Lifestyle Factors

  HELPERS - Treatment.
  • Hidradenitis: Aloe Vera Herb.
  • Hidradenitis: Anti-Inflamm Foods.
  • Hidradenitis: Apple Cider Vinegar.
  • Hidradenitis: Bleach Bath.
  • Hidradenitis: Fiber Rich Foods
  • Hidradenitis: High Dose B-12.
  • Hidradenitis: Honey, sweetner.
  • Hidradenitis: Neem herb oil.
  • Hidradenitis: Omega 3 Fats
  • Hidradenitis: Rubbing Alcohol.
  • Hidradenitis: Sweetners, herbal.
  • Hidradenitis: Tea Tree Oil.
  • Hidradenitis: Turmeric herb.
  • Hidradenitis: Vitamin D Supplement
  • Hidradenitis: Warm Compresses.
  • Hidradenitis: Whole Foods
  • Hidradenitis: Zinc minerals.

    OTHER:

    Hidradenitis: Biologics medication..

    Hidradenitis: Clothing modifications.

    Hidradenitis: Corticosteroid drugs.

    Hidradenitis: Hormone adjustments.

    Hidradenitis: NSAIDS .

    Hidradenitis: Oral Retinoids

    Hidradenitis: Shaving

    Hidradenitis: Surgery.

Hidradenitis suppurativa (HS) is a debilitating and distressing chronic inflammatory skin disease affecting about one in every 150 Australians. It is characterized by recurrent, painful, deep-seated, multiple skin nodules, most commonly located in the axillary, inguinal, perineal and perianal regions, the submammary and intermammary folds, and the buttocks. Complications include abscesses, sinus tracks, fistulae, and scarring. Although hidradenitis suppurativa is often referred to as acne inversa, it is not a form of acne and lacks the core defining features of acne such as the presence of closed comedones and increased sebum production. Diagnosis is often delayed for many years and misdiagnosis can result in ineffective and potentially harmful treatment.

The hidradenitis suppurativa bumps are often mistaken for pimples, boils, or folliculitis.
You can recognize a hidradenitis suppurativa breakout because it typically causes bumps on both sides of your body that tend to return in specific locations ....

Many medical disciplines and services, including general practice, emergency medicine, surgery, infectious diseases, gastroenterology, gynaecology, and mammography services, are well placed to recognize HS and to refer patients to dermatologists for early effective treatment (but do NOT).

In 1839, Velpeau identified and described hidradenitis suppurativa. FACTORS Index
With a largely REACTIVE association of it with other skin diseases, further research and discovery has been largely avoided for 150 years!.
Treatments have tended to be based on the assumptions, projections, superstitions, and prejudices of the healthcare agent. Most sources of treatment ... pharmaceutical, device, surgical, herbs, lifestyle ... have proven to be of minimal, inconsistent, and selective success .. suggestive of a placebo effect. .

Routine culture of HS lesions regularly fails to demonstrate infection, and if bacteria are identified they often comprise normal flora.
However, systemic antibiotics are widely used in treatment, both short-term for the control of acute infective episodes and long-term for their presumed immunomodulatory properties.

Hidradenitis suppurativa (HS; also designated as acne inversa .. and many other localized names) is a chronic inflammatory disorder, which affects the intertriginous skin and is associated with numerous systemic comorbidities. ... The comorbidities of HS include metabolic and cardiovascular disorders, which contribute to reduced life expectancy. A genetic predisposition, smoking, obesity and hormonal factors are established aetiological factors for HS. Cutaneous changes seem to start around hair follicles and involve activation of cells of the innate and adaptive immune systems, with pivotal roles for pro-inflammatory cytokines such as tumour necrosis factor, IL-1ß and IL-17.

The unrestricted and chronic immune response eventually leads to severe pain, pus discharge, irreversible tissue destruction and scar development. HS has profound negative effects on patients’ quality of life, which often culminate in social withdrawal, unemployment, depression and suicidal thoughts. The therapeutic options (largely inconsistent in effectiveness) for HS comprise antibiotic treatment, neutralization of tumour necrosis factor and surgical intervention together with lifestyle modification. Nevertheless, there is an enormous need for awareness of HS, understanding of its pathogenesis and novel treatments.

The exact cause of hidradenitis suppurativa isn't known. FACTORS Index
It develops when hair follicles in the skin become blocked.
Experts think it could be connected to hormones, inherited genes and immune system problems.
Smoking, excess weight and metabolic syndrome also might play a role.

Hidradenitis suppurativa is not caused by an infection or being unclean, and some authors state that it can't be spread to other people.

The inflammatory cascade in HS involves tumour necrosis factor (TNF)-a, interleukin (IL)-17 and interleukin-1ß.
Recognizing HS as an autoinflammatory disease, and not a result of infection, has important clinical implications including the need to address comorbidities such as visceral adiposity, insulin resistance and hormonal factors that can activate or exacerbate the underlying inflammatory mechanisms. About one-third of patients have a family history of HS, and at least 23 potentially pathogenic gene sequence variants have been identified. The microbiome in HS differs significantly from healthy controls in both affected and non-affected skin. Bacterial infection, when it does occur, is likely to be secondary to skin damage and underlying inflammation rather than a primary contributor to pathogenesis.

Behaviours and conditions associated with HS include current or former smoking, elevated body mass index, polycystic ovary syndrome, pyoderma gangrenosum, pilonidal cysts, and other inflammatory conditions including rheumatoid arthritis and inflammatory bowel disease (essentially, ANY Significant immune stimulation that becomes chronic).

HS is characterized by the inter-related features of pain, depression, anxiety, disability and impaired quality of life, and comorbid depression is common

Comprehensive care of HS should include encouragement of smoking cessation and weight control, wound care, and management of pain, itch and psychosocial health. Topical therapies alone may be effective in mild HS. Systemic antibiotics are widely used short-term for the control of acute infective episodes and long-term for their PRESUMED immunomodulatory properties.

Adalimumab is the only biologic registered in Australia and New Zealand for the treatment of HS. Surgery is an effective adjunct to medical treatment for HS. Laser therapy, photodynamic therapy and intense pulsed light can also be useful adjuncts to medical therapy.

Bleach baths and topical disinfectants such as chlorhexidine aim to maintain skin hygiene, reduce bacterial colonization and potentially suppress the triggers of an aberrant immune response. Laser and light-based therapies have the potential to reduce the frequency of painful flares by decreasing the number of hair follicles, sebaceous glands and bacteria in affected areas, and to ablate chronic problematic lesions. Ablative CO2 laser therapy has been used to deroof sinus tracts, vaporize them until no affected tissue is visible, and completely excise them along with perilesional skin.

Nearly a quarter of patients state that nothing relieves their symptoms.

Complications
FACTORS Index
Persistent and severe hidradenitis suppurativa often causes complications, including:

• Infection. The affected area is susceptible to infection.
• Scars and skin changes. The wounds may heal but leave rope-like scars or pitted skin.
• Restricted movement.
  Sores and scar tissue may cause limited or painful movement, especially when the disease affects the armpits or thighs.

• Obstructed lymph drainage.
  The most common sites for hidradenitis suppurativa also contain many lymph nodes.
  Scar tissue can interfere with the lymph drainage system, which may result in swelling in the arms, legs or genitals.

• Social isolation.
  The location, drainage and odor of the sores can cause embarrassment and reluctance to go out in public, leading to sadness or depression.

Foods that may cause hidradenitis suppurativa flare-ups
FACTORS Index

Dairy
Milk and other dairy products may raise levels of certain hormones ... ...

Dairy products include:

• cow’s milk
• cheese
• cottage cheese
• cream cheese
• buttermilk
• butter
• yogurt
• ice cream

Sugary foods
Sugary foods and refined, simple carbs can cause a spike in blood glucose.
... this may trigger inflammation and cause symptoms. ...

• table sugar
• corn syrup
• high-fructose corn syrup
• soda and other sugary drinks like fruit juice
• bread, rice, or pasta made from white flour
• white flour
• noodles
• boxed cereals
• biscuits and cookies
• cake, doughnuts, and pastries
• crackers made from refined flour
• potato chips
• candy
• chocolate bars
• sugary protein bars

Brewer’s yeast
... the yeast causes a reaction in your immune system.
(Products) that may contain this ingredient, including:

• beer
• wine
• fermented spreads
• some soy sauces
• some stock cubes
• some dried or canned soups
• some breads, cakes, and pizza
• some gravies and dips
• some vinegar and salad dressings
• some health supplements

Other factors
...some people ... report that eliminating nightshades from their diet improves symptoms.
Nightshades are a group of plants that include edible vegetables like eggplants, potatoes, tomatoes, and peppers.

... hidradenitis suppurativa is associated with several autoimmune conditions such as lupus and IBD.
If you would like to eliminate nightshades in your diet, cut out the following foods:

• tomatoes and tomato products
• eggplant
• potatoes
• peppers
• paprika
• tomatillos
• chili powder
• pepper containing spice blends

... lifestyle factors that cause or worsen symptoms include:

• smoking cigarettes
• tobacco use
• obesity or weight gain
• ingestion of foods with gluten if you’re gluten intolerant

Foods that may help hidradenitis suppurativa symptoms
FACTORS Index

Fiber-rich foods
Foods that are high in fiber help balance blood sugar and hormone levels. ...

Replace simple, sugary carbohydrates with whole foods and complex carbohydrates, such as:

• fresh and frozen fruit
• fresh and frozen vegetables
• fresh and dried herbs
• lentils
• beans
• brown rice
• barley
• oats
• bran
• couscous
• quinoa

Omega-3 fatty acids
... omega-3 fatty acid foods may help to reduce inflammation in your body. ...

• salmon
• sardines
• walnuts
• flax seed and flaxseed oil
• avocados
• olive oil
• pumpkin seeds
• chia seeds

Natural sweeteners
... Choose foods and drinks made with natural sweeteners that don’t raise blood sugar levels drastically.
Try replacing sugary drinks with sparkling or plain water, reducing the amount of sweetener you add to foods
and beverages, and cutting back on foods high in added sugar, like candy, cakes, and sports drinks.

• stevia
• monk fruit

Warm compress
A warm compress can immediately reduce pain in the affected area.
For best results, use a dry source of heat, like a heating pad, instead of a hot washcloth.
Keeping the area dry can help it heal faster.

Turmeric
Turmeric has strong anti-inflammatory, antimicrobial, and antibacterial properties.
It may help reduce inflammation and prevent infection from developing.

To use as a treatment, you can mix 1 tablespoon of turmeric with 1/2 tablespoon of carrier oil, like coconut oil.
Apply the mixture directly to the affected area for 15 minutes.
If this is irritating or too warm, rinse well with cool water and let the area rest before trying again.

Honey
Like turmeric, honey has long been used for its antimicrobial, healing, and anti-inflammatory properties.
It also has antibacterial properties that may prevent infection. You can mix honey with turmeric for added power and apply it to the affected area. Leave it on for 15 to 20 minutes before washing it off.

Tea tree oil
Tea tree oil has been used for thousands of years for its antimicrobial, antibacterial, and anti-inflammatory properties.
Mix a few drops of tea tree oil with 2 tablespoons of a carrier oil and apply it to the area directly.

Aloe Vera
Aloe Vera is known for its strong anti-inflammatory and antiseptic benefits.
It can soothe the inflammation and discomfort of flare-ups.
Use pure aloe vera gel (with no additives) and apply it directly to the affected area.
You can let it soak into your skin.

Rubbing alcohol
Rubbing alcohol is a strong disinfectant.
It may help remove dirt and impurities from clogged pores. It might even soothe pain or irritation during a flare-up.

To use rubbing alcohol, add to a cotton pad and apply it to the affected area.
This shouldn’t be used on open wounds, as it can cause a burning pain.

Zinc
Zinc can help reduce inflammation and swelling in your body.
You can take zinc supplements or find it in foods like spinach or oysters.
You can also make a cream with 1 tablespoon of beeswax, 1 teaspoon of zinc oxide powder, and ½ cup of coconut oil.

Neem oil
Neem oil has long been used to treat skin conditions like acne.
It can help reduce bacteria, redness, and inflammation. It also contains a high fatty-acid content,
which may aid in healing scars.

Apply Neem oil directly to the affected site with a cotton ball or pad. You can wash it off or let it soak into your skin.
It can also be combined with other ingredients like aloe, honey, or turmeric.

Apple cider vinegar
Apple cider vinegar might not do much to treat flare-ups directly, but it may prevent bacterial infections from developing.
Put a small amount of apple cider vinegar on a cotton pad and apply it to the affected area.
You can leave it on and let it soak into your skin.

Bleach bath
Some people claim bleach baths help chronic skin infections, with the thought that it may even aid in faster recovery.
Because of the harsh nature of bleach, however, consult your dermatologist or primary care physician before use.

To try a bleach bath as a treatment, add around 1/3 of a teaspoon of household bleach (2.2 percent concentration) per quart of warm water. Keep your head completely above water at all times. Soak in the bath for 10 minutes before showering in clean water and drying your skin thoroughly.

Eat anti-inflammatory foods
Foods with anti-inflammatory properties may help prevent and reduce swelling and inflammation.
Following an anti-inflammatory diet may reduce flare-ups of hidradenitis suppurativa and possibly help current symptoms to resolve faster.

Anti-inflammatory foods include:

• cinnamon
• salmon and other oily fish
• walnuts
• green tea
• ginger
• dark chocolate

Supplements
FACTORS Index
... high-dose B-12 supplementation improved symptoms in patients ...

... are more likely to have low blood levels of zinc, and zinc supplementation may lead to partial or complete remission in patients that don’t respond to other treatment.

... more likely to have low levels of vitamin D, and supplementation with this nutrient may reduce symptoms.

Biologics Medications. These medications work on your immune system, your body's defense system against germs.
You take them by getting a shot, either at the doctor's office or at home.
Or you may need to get the meds through an IV in your veins. This is done at a clinic or hospital.

These drugs include:
• Adalimumab (Humira). --- This medicine is the only one approved by the FDA to treat HS.
• Infliximab (Remicade). --- The FDA hasn’t approved this for HS, but doctors still use it.
• Anakinra, canakinumab, and ustekinumab.
  --- These medications may help some people with severe or hard-to-treat HS.
  -------Researchers are studying how well they work.

Other medications. These include:

Metformin (Glucophage).
Doctors use this to treat adult-onset diabetes and metabolic syndrome. It may also help patients with HS.

Methotrexate (Xatmep).
It is a pill, shot, or IV that controls the inflammation of psoriasis and other medical conditions, including some cancers.
It works on your immune system and may help control HS in some people.

Clothing Modifications. FACTORS Index
Outfits that are tight can irritate skin sensitized by a toxin, drug side effect, nutritional deficiency, or, other ailment.
Beginning in 2018 and particularly after 2020, with my bulk continuing to expand uniformly overall, my clothes had been exchanged, from underwear to outerwear, to a larger size. Even this modification eventually became snug and then tight. Beginning in late 2021, I found it mandatory, if I were not to be constantly aggravated by a sense of smothering .. to go naked in my apartment. This provided me with a sense of normality and enabled Calm. Focus, and, Flexibility of thought. This would NOT be an option for others who could and chose to go out socially often, were not retired or financially self-sufficient, or, living alone.

Corticosteroid Drugs.
Your doctor injects these medicines into the bumps.
They can ease inflammation, pain, and swelling.
You usually get these shots once a month for up to 3 months.
If your case is severe, your doctor may recommend that you take steroid pills by mouth.

Hormonal Modifications. FACTORS Index
It has been found and is suggested that, for some women, the use of Birth Control Pills, or the drug spirolactone will reduce symptom severity.
Spironolactone works by regulating oil production, blocking acne-causing androgen receptors, normalizing blood pressure irregularities and, as a diuretic, improving water retention difficulties. Increased androgens (including testosterone) can increase sebum production, which leads to clogged pores. It also may alter blood potassium levels, therefore, people with kidney disease should not take it. As the alteration of androgen levels can also influence fertility, those wishing to become pregnant are also best to avoid it. Spironolactone can alter the body's electrolyte balance (potassium, magnesium, and calcium) ... thereby leading to low sodium. An imbalance of electrolytes can lead to muscle cramps, which can be particularly problematic during menstruation, if cramps are already an issue. Fatigue can also result from a lowered blood pressure level and from modified hormone levels and if this results, the patient may wish to discontinue use of it.

NSAIDS (nonsteroidal anti-inflammatory drugs).
These over-the-counter medicines can ease your pain and help manage swelling. They include:

Aspirin
Ibuprofen
Naproxen

Oral Retinoids.
Your doctor may suggest a retinoid medication in a pill such as acitretin (Soriatane)
or isotretinoin (Accutane). Both can improve severe cases of HS.

Shaving considerations. FACTORS Index
I found that the removal of hair that was longer than 1/16th of an inch, from my scalp, greatly reduced the skin reddening, itching, and distraction. Use of a safety or straight razor can both irritate the skin and spread the symptoms, plus, require constant resanitizing and cleaning of the instrument. I used a rotary 3-head electric razor to shave my scalp as often as 3 times daily, Pushing the metal blade covers tight to the scalp enabled the constantly refilling pimple-like follicle eruptions to be broken and cleared of most of their contents. Breaking these increasingly sensitive and sore eruption was, for me, extremely painful for the few seconds each was impressed. Development of pain suppression was impossible as such requires a longer and constant presence of pain to enable one's Reptilian Structure to adapt to any specific pain source. I cleaned the blades of my electric razor daily, to maintain the razor from becoming clogged or obstructed. I often cleaned the razor blades, mounting, and housing with a liquid wash and disinfectant spray. For me, NO medication or drug or supplement provided as much benefit.

Surgery.
If your bumps grow deep into your skin, you might have a surgical procedure.
If you're having problems in a small area, your doctor can cut open pockets to drain pus.
This gives you short-term relief.

In a procedure called deroofing, your doctor turns deep, painful bumps and pockets into scars that won’t hurt.
It's an option if you have painful bumps that come back over and over.

Another type of surgery involves cutting out skin in the problem spots.
Afterward, your doctor will do a skin graft.
They take skin from another part of your body and use it to cover the area where you had the operation.

Laser surgery is another option to clear new, deep bumps.
It destroys hair follicles, the shafts in your skin where hair grows. You may need several treatments.

Success rates for HS surgery can vary long-term.
Surgery can help with stubborn or severe cases of HS, but your HS may come back in the same part of your body or somewhere else.

ULTIMATELY, as of 2023-09-26 Hidradenitis suppurativa (HS) is

NOT caused by bacteria, fungus, virus, other parasite.

has NO lab test that is relevant as no cause is known to be tested for.

WITHOUT any aids that lead to a Recovery, and therapies are largely Guesses.

Immune system distraction is ALWAYS evident and co-mobilities are encouraged.

Openness to causal uniqueness by diagnosticians is blurred by an obsession on treatments.

Scalp mite overburden (near inviable insects) and largely avoided in testing ... might be an overlooked origin.

FACTORS Index