Hidradenitis suppurativa (parts1,2,3,4)
When I look at the treatment protocol recommended by American Academy of Family Physicians, I get the impression that it is designed to maximize profit, prolong illness and minimize patient benefit.
“Hidradenitis suppurativa is considered a medical mystery when viewed from the pathologic-pharmacocentric model.
You know I don’t play that game.” DrV
1. Description and Medical Treatment
Hidradenitis suppurativa (HS) is a chronic debilitating inflammatory skin disorder characterized by excess inflammation (eg, increased cytokine and chemokine secretion) and somewhat paradoxical impairment of immune defense (decreased expression of innate immunity markers such as toll-like receptors 2, 3, 4, 7, and 9; intercellular adhesion molecule 1, etc1) against microbes, especially Gram-positive bacteria.
The disease is essentially a chronic and exaggerated inflammation of the unit of hair follicles and sweat glands, or—as we like to say in the snack room—the folliculopilosebaceous unit. One might think that we would just treat this as a type of chronic severe folliculitis (hair follicle infection) but NO—we have to make it much more complicated than that.
Note that this hyperinflammatory-hypodefensive paradox is observed in various granulomatous diseases. Note also that the hyperinflammatory-hypodefensive paradox is characteristic of vitamin D deficiency—more on that later as we have data specific to HS, but if you know my work then you already know where I am going with that idea.
Medical treatment sits and spins around 1) systemic drug antibiotics, 2) topical drug antibiotics, 3) denial of the existence of nutrition, 4) expensive and repeatable office procedures such as biopsies and skin excisions, and 5) high-level “biologic” anti-inflammatory drugs that cost more per year than the average salary of the average American (which is ~USD$55,0002 ).
In fact, when I look at the 2019 treatment protocol* recommended by the American Academy of Family Physicians, I get the impression that it is designed to maximize profit, prolong illness and minimize patient benefit.
*IMAGE ABOVE FROM "Hidradenitis Suppurativa: Rapid Evidence Review" in American Family Physician 2019;100(9):562-569 published by American Academy of Family Physicians
2. Obvious need for topical antimicrobial treatment, specifically with povidone iodine
OK, I will go out on a limb here and state the obvious: that any recurrent bacterial infection of the skin should be addressed with use of topical povidone iodine. There, I said it.
This post took at least 8 hours of work. This specialty post is reserved for paid subscribers and other people nice enough to buy me a coffee to support the time and effort. Yes, this post is awesome and packed with great information, but it is not personalized medical advice.