Hidradenitis suppurativa is a chronic inflammatory skin disease.

It occurs due to infection of apocrine sweat glands of the hair follicles, causing painful boils (pus filled bumps), nodules, cyst and sinus tract formation over the skin.

Sites affected : Mostly in the area of skin folds i.e.

  • Axilla (armpits)
  • Groin
  • Thighs
  • Buttocks &
  • Under the breasts



Hidradenitis suppurativa is seen to occur more in females than in males.

It usually occurs during Puberty, and rarely in childrens and adults.



The exact cause of this disease is not known.

However, there are multiple risk factors that are associated with this condition :-

  • Obesity
  • Smoking
  • Excessive sweating
  • Wearing tight fitting dresses


It starts with the infection and inflammation of the apocrine sweat glands and its ducts, along with ‘Follicular Keratosis’, which means blockage of the hair follicle.

The sweat gets accumulated under this blockage, leads to painful tender pus filled bumps / boils over the skin. This may burst, causing more inflammation, nodules, cyst & sinus tract formation.

Upon healing, it leaves huge scars over the skin.



  • Recurrent boils in the areas of skin folds (mentioned above) – These areseverely painful and associated with oozing of pus as well as
  • Huge scar formations – due to repeated appearances of boils over the same area of the skin folds and recurrent healing. Scarring leads of painful restriction of movement and depression.
  • It can prevent people from going out frequently, wearing their favorite clothes etc. Hence, it severely affects the quality of lifestyle.



Hidradenitis suppurativa can be diagnosed byclinical examination and History taking of the patient.

The patient usually presents with a history of recurrent boils.

A characteristic finding in Hidradenitis suppurativa is ‘Double comedones’ i.e. a papule containing two black-heads, commonly in the axilla.

Other findings includes cysts, nodules, sinus tracts etc. which helps in confirming the diagnosis.



  1. General measures
    1. Avoid risk factors which aggravate the disease, such as :-
      • Obesity – lifestyle modification
      • Avoid smoking
      • On Excessive sweating, bathe thorougly and keep the body surface dry, especially in the areas of skin folds.
      • Avoid tight fitting clothes, which may cause increased sweating. It is preferable to wear loose cotton clothes.
      • Proper cleaning of the pus, oozing out from the infected areas, followed by proper dressing.
    2. For excessive pain, painkillers can be used.
    3. Chronic cases of Hidradenitis suppurativa can cause the patient to be depressed, which also needs to be addressed.


  1. Medications
    1. Topical antibiotic creams
      • Erythromycin cream
      • Azithromycin cream
      • Fusidic acid cream
      • Benzoyl peroxide
      • Mupirocin cream etc.
    2. Oral antibiotics – These are used in long term therapy
      • Rifampicin
      • Clindamycin (combined with Rifampicin is found to be very effective against Hidradenitis suppurativa)
      • Doxycycline
      • Minocyclin
      • Tetracycline
      • Erythromycin
      • Isotretinoin capsules are effective. It is also used in treatment of pimples.
    3. In case of large cysts, incision of the cyst and drainage is performed.
    4. Intra lesions Steroid injection
    5. Some other drugs have been found to be effective in this condition, which are currently in trial phase:-
      • Zinc
      • Cyclosporin
      • Anti androgen
      • Oral contraceptive pills

The above medicines/drugs/procedures have been found to be effective in the treatment of Hidradenitis suppurativa. However, not all drugs are suitable for every patient.

The appropriate drug of choice, its dosage and duration is best prescribed by a professional clinician.

It is advised to consult your doctor before starting any medicine.


  • Monoclonal Antibodies / ‘Biologicals’ – These are the most recent advancement in the treatment of Hidradenitis suppurativa:-
    • Infliximab
    • Etanercept
    • Adalimumab – used widely &USFDA approved; administered via subcutaneous injection

Monoclonal antibodies are one of the best methods of treatment, but is very expensive.


After the control of infection and inflammation by the above methods, hair removal and scar removal can be achieved by Laser therapy, such as CO2 laser. This leads to long term relief of the patient.


  1. Surgical Management- It is done in highly resistant and advanced stages of this condition. In such cases, surgery proves to be essential and curative.

In it, the sweat glands within the affected area are surgically removed. It leads to a permanent cure of this condition, without any chances of recurrence.



Granuloma Annulare (GA) is a relatively uncommon skin condition, characterized by red/skin colored circular asymptomatic Rash with elevated borders and central depression, closely resembling ring worm.



As mentioned earlier, it is a relatively uncommon skin condition/disease.

It is seen more commonly in children and in females.

Incidence after the age of 30 is rare.

It can be associated with Diabetes and thyroid problems.



Cinical features of Granuloma Annulare (GA) includes :-

  • Characteristic asymptomatic ring-rashes that are slightly elevated in the periphery and depressed in the middle.
  • It can closely resemble ‘daad’ or ringworm infection.

GA rashes are mostly asymptomatic. Pain and itching is rarely seen in this condition. However, cosmetic problems and appearance of the skin is the major cause of treatment.



  1. Localized GA – it appears in isolated areas of the body, mostly seen in the dorsum of Hand and foot.
  2. Generalized GA – It is characterized by multiple small rashes all over the body, which may combine to turn larger rashes. It appears more on the sun exposed part of the body.



  • Diagnosis of GA can be done by simple clinical examination by any professional dermatologist.
  • In a variant called papular Granuloma Annulare, the rashes appear different from the classical form. In such cases, Skin biopsy is done to confirm the diagnosis.
  • GA is usually asymptomatic. So rarely, if a patient complains of pain and itching, KOH test is done to rule out fungal infection (ringworm)

In KOH test, the skin is gently scraped on the surface and a sample of the skin is collected and sent to the laboratory, to detect the presence of fungi.



GA is normally self-limitingand resolves within 1-2 years.

However, various methods for prompt treatment are also available :-

  1. Steroid creams – High potency steroid creams like Clobetasol, Halobetasol, Mometasone.
  2. Intra lesions Steroid injection for rapid resolution.
  3. Oral medicationsDapsone, Isotretinoin, Hydroxy chloroquine, Niacinamide etc.
  4. In resistant cases (rashes do not go away easily, even on treatment), biological medications, such as Infliximab, Etanercept, Adalimumab can be used. However, these are very costly.


Granuloma Annulare is a chronic disease, and recurrence is common on old sites, even after resolution/treatment of previous rashes. However, the recurrent cases are easily curable and is not cause for much concern.