Monday, April 21, 2014

Definition

Hidradenitis (also called hidradenitis suppurativa) is inflammation of the apocrine sweat glands located under the armpits, around or close to the anus, in genital area and under the breasts.

Description

The exact cause of hidradenitis is unknown, however researchers believe it may be caused by an endocrine (gland) disorder, with plugging of the apocrine ducts, or an infection caused by a variety of bacteria, including staphylococcal bacteria.

Staphylococcal bacteria lives on the human skin and is relatively harmless. However, if the bacteria becomes trapped within the skin by a blocked sweat gland, the bacteria may cause superficial skin infections such as pustules (skin blister), boils (painful, pus-filled, inflamed hair roots, also called furuncles), abscesses (collection of pus in a solid tissue), or carbuncles (a cluster of interconnected boils).

Causes

In the case of hidradenitis, boils can form in the affected areas from extended use of antiperspirants, deodorants or depilatories (hair removal products).

Shaving, tight fitting clothes, open wounds or recurrent folliculitis (inflammation of the hair follicles) are also known to aggravate the skin and cause the bacteria to enter the skin.

Symptoms

The symptoms of hidradenitis include:

  • Fever
  • Pain and tenderness in the involved area(s)
  • Boils just under the skin
  • Discharge of pus through specially formed tracts (suppuration)
  • Weight loss

In later stages, a mass with scarred bands of tissue may occur in inflamed areas.

Diagnosis

The diagnosis is made clinically by history and physical examination.

Treatment

People affected by hidradenitis should avoid use of antiperspirants or other skin irritant chemicals including depilatories.

The symptoms of this condition are usually treated with rest, moist heat to extract the pus from the boils, application of warm, wet dressing with topical antibiotics to the affected areas, as well as, oral antibiotics.

Corticosteroids (i.e., prednisone) and retinoids (such as isotretinoin) may also help treat the skin lesions. In some cases, corticosteroids may be injected into the skin lesions.

Surgery of the affected areas may be necessary in the most persistent cases. Two types of surgical removals include (1) excision/split skin grafting, and (2) excision/local skin flap cover.

Split skin grafting is a technique used in plastic surgery to repair areas of lost or damaged skin. A piece of healthy skin is removed (excision) from one part of the body and transferred to the affected area.

Skin flap is a surgical procedure in which a section of the skin and underlying tissue (called a flap) is removed (excision) to cover an area from which skin and deeper tissue have been lost or damaged. Unlike a skin graft, a flap retains its blood supply.

Questions

Besides the use of antiperspirants or depilatories, is there anything else that can exacerbate the condition?

Do you recommend antibiotics?

Do you recommend surgery? If so, which type? What is the recovery time?

Will the scarring be noticeable?

What is the prognosis?