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Managing the painful skin condition is difficult, but slick layers of bacteria known as biofilms can make it even more difficult. Here’s what scientists are learning about the two’s interplay.

It may not be the most common skin condition (affecting roughly 1% of the global population) or the easiest to pronounce. But if you have hidradenitis suppurativa (HS), you know it’s one of the most excruciatingly painful conditions. “HS is characterized by large, inflamed boils in areas like the armpits, groin, and breast area,” says Dr Adil Moulanchikkal, Lead Ayurveda Specialist at EliteAyurveda Clinics.. If it doesn’t sound like a lot of pain, consider this: These boils frequently break, causing a tunneling effect beneath the skin, where biofilms can form.

Biofilms, slimy layers of bacteria that stick to damp surfaces, are particularly resistant to antibiotics, which is concerning for HS patients who rely on long-term courses of the drugs to regulate their disease. In fact, a recent study by the Academy of Dermatology and Venereology discovered that biofilms drastically reduced people’s sensitivity to tetracycline and clindamycin, two typical antibiotics used to treat HS in allopathy medicine.

While scientists are still learning about the function biofilms play in the development of HS, there are several important facts that everyone living with this difficult disease should be aware of.

#1. HS Is Still a Mystery

Those suffering from HS are all too acquainted with the questions surrounding the disease, from what causes it to which medical field should “own” it. It’s a small comfort, but it’s still a mystery to researchers. “There’s a logical reason we don’t know a lot about HS,” explains Dr Adil. “There has been a dearth of studies and funding focused on it for as long as we’ve known it exists.” In comparison to other common inflammatory skin disorders, the quantity of research published on HS over the last 20 years has been negligible. It is a terribly underserved disease.”

#2. It’s Extremely Sweaty

HS is more likely to emerge after puberty in places of your body where skin-on-skin contact occurs, such as your armpits, under the breasts, and vaginal region. Scientists believe that skin lesions arise as a result of inflammation around hair follicles, which causes them to become painful and swollen. These can then become infected with pus and blood, causing excruciating discomfort. Obesity and smoking appear to play a role in the development and severity of HS, while the condition affects many patients of normal weight who have never smoked. Because 30% to 40% of persons with HS also have a family member with the disorder, there may be a genetic component to the disease.

#3. The Biofilm Factor Is a Contentious Issue

While evidence indicates a relevant link between HS and biofilms, the specific sequence of events remains unknown. “We now have a handful of studies that have looked at biofilms and HS,” says Dr Adil, “and I think we can say with pretty good certainty that biofilms exist in sinus tracts (the pus-filled tunnels’ beneath the skin in HS sufferers), because these tracts are filled with bacteria, and of course they’ll try to protect themselves by making this material that we commonly call biofilms.”

Are they, however, the cause or the effect of this inflammatory condition? “We need to do more research on what’s the chicken and what’s the egg,” she admits. “Does the inflammatory response come first, and then the bacteria?” Or do the bacteria end up somewhere they shouldn’t be, triggering the inflammatory response?” Some evidence suggests that biofilms do not form in early lesions but form later to play a function in disease maintenance. In any case, once they are in place, they throw a wrench in treatment.

#4. Biofilms tamper with medicines

Biofilms are actual structures composed of proteins, lipids, and other substances. They are gooey substances, similar to mucus in your nose; bacteria discharge these materials and create the biofilm to protect themselves, shielding the germs from anything that tries to remove it—specifically, antibiotics. According to researchers at the Centre of Biomolecular Sciences, in the case of HS, this structural slime effectively seals the bacteria inside the tunnels that have formed under your skin, preventing medicines from reaching them and killing them off.

#5: Biofilms Aren’t Just for Humans!

It can be difficult to understand what biofilms are since the variety, both bacterial and fungal, is so enormous. Biofilms do not even have to form on people; they have been observed on industrial objects such as drain pipes and medical devices, as well as plants. Slime-encapsulated bacteria colonies are at the root of many chronic illnesses and disorders, including urinary tract and middle-ear infections, as well as gingivitis. (You know that sticky muck that builds on your teeth after not brushing them for an entire day? That is a biofilm!). Biofilms also play a role in more serious conditions such as endocarditis.

#6. Technology is becoming more adept at detecting them.

Biofilms do not form in every person with HS. However, like with almost everything concerning hidradenitis suppurativa, early detection of biofilms may enhance treatment outcomes, as it indicates to clinicians that antibiotics may not be as successful, and other techniques to treating HS may be more effective. Tissue-culture plates (which stain cells with crystal violet dye); a bioluminescent technique based on the signals of certain metabolically active cells; scanning electron microscopy, which is used to study the structure and number of bacteria in a colony; and confocal scanning laser microscopy, which provides a three-dimensional view of the microbial community are all methods for detecting biofilms in HS. The medical community’s awareness and capacity to detect the existence of biofilms has substantially improved as a result of these cutting-edge diagnostic approaches.

#7: Research is Increasing

There is no one treatment available to eliminate biofilms in persons with HS at the moment. That’s partially due to the vast variety of existing biofilms (there will never be a one-size-fits-all solution), and partly due to the fact that biofilms have developed over eons with the express purpose of safeguarding their precious cargo, so they’re not going down without a fight. Nonetheless, researchers are increasingly uncovering promising approaches. For example, researchers discovered that a compound known as “darwinolid,” which was discovered in an Antarctic sea sponge, appears to be effective in preventing the formation of a biofilm for methicillin-resistant Staphylococcus aureus—or, as the rest of us know it, a staph infection that can cause pneumonia or even heart failure. Another possible strategy is to utilize biological agents, electrical impulses, or other techniques to disrupt, impede, or scramble the chemical signals used by cells inside a biofilm to communicate with one another.

#8: Treatment is still evolving. What’s the bottom line? 

The precise association between hidradenitis suppurativa and biofilms remains unknown, even as researchers explore innovative techniques for disrupting—and possibly preventing—the formation of biofilms in HS patients. Because treating biofilms directly is still a work in progress, the majority of therapy options currently focus on HS itself. 

Another method involves “unroofing,” or cutting skin tissue in the affected area to expose the tunnels beneath the skin and allow pus to drain, alleviating the pressure that is such a painful aspect of the disease for many patients. In advanced stages, your doctor may recommend surgical removal of the afflicted areas, which may include lengthy wound healing and skin grafting in some cases.

The degree of risk varies depending on the surgical treatment. Which is the greater danger. Because HS is a systemic illness, treating one area of skin does not prevent the disease from spreading to another. Outside of the treated region, new tunnels will frequently form. 

A recent study discovered a 35% recurrence incidence among HS patients who underwent surgery.

There are always hazards associated with every medical practice. According to Dr. Adil, all skin operations, for example, include a risk of bleeding or infection. “Scarring will also result from these procedures, and the appearance of that scarring will vary greatly,” he says.

In Ayurveda, hidradenitis suppurativa Treatment is to restore the body’s natural equilibrium by detoxifying it with potent herbal therapies. 

The treatment for Hidradenitis Suppurativa at Elite Ayurveda comprises balancing the Kapha and Pitta doshas, as well as providing harmony to the metabolism. The treatment comprises body detoxification, internal drugs to balance doshas, and external applications to heal scars.

The treatment involves combinations of herbs created based on individual Prakruti and Vikruti analysis. 

While HS is still a difficult condition to live with, increasing research into biofilms may one day result in more successful treatment techniques for patients suffering from the disease. Until then, consult with your doctor about the best strategy for staying one step ahead of HS.

Our Outlook –

Under one roof, we at EliteAyurveda Clinics have a panel of specialists in numerous dimensions of medical domains such as endocrine, autoimmune, gynecology, and so on. We are well-known for taking a multifaceted and root-cause approach to treating chronic and difficult-to-treat disorders.

Contact us to learn more.

According to Ayurveda, hidradenitis suppurativa is a cause of Kapha and Pitta dosha. When the digestive fire (Agni), or Pitta, is out of balance, the Kapha Dosha becomes vitiated, which slows down metabolism. Due to the disruption of fat molecules, they start to build up in muscles and impede bodily passageways, causing painful, swollen sores in the groin, buttocks, thighs, and armpits.

In Ayurveda, hidradenitis suppurativa Treatment is to restore the body’s natural equilibrium by detoxifying it with potent herbal therapies. 

The treatment for Hidradenitis Suppurativa at Elite Ayurveda comprises balancing the Kapha and Pitta doshas, as well as providing harmony to the metabolism. The treatment comprises body detoxification, internal drugs to balance doshas, and external applications to heal scars.

The treatment involves combinations of herbs created based on individual Prakruti and Vikruti analysis. Visit our website to know more

Connect with us to get our patient testimonials and also to speak with our patients directly about their experience in getting their disease treated by us and by Ayurveda as a whole.

Medically reviewed by Dr Adil Moulanchikkal, Lead Ayurveda Specialist at EliteAyurveda Clinics. With over 15 years of experience in treating Neurological, Skin & Autoimmune Diseases.


Know More About Ayurveda Treatment For Hidradenitis Suppurativa.