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Hidradenitis is a chronic disease of the scent or apocrine glands which causes chronic scarring and pus formation of the axillae and groin areas. It is similar to acne which is a disease of the sebaceous glands. This condition is slightly more common in African-Americans and women. Hidradenitis usually starts as one or more red, tender, swellings in the groin or axilla. Over a period of hours to days the lesions enlarge and often open to the skin surface draining clear to yellow fluid. The involved area then heals with scarring. The condition usually continues for years with periods of flare and remission.
Hidradenitis Suppurativa (HS), also known as ‘Acne Inversa‘, is a physically, psychologically, and socially disabling disease affecting inverse areas of the body (those places where there is skin-to-skin contact – armpits, groin, breasts, etc.), and where apocrine glands and hair follicles are found. It is non-contagious and recurrent; typically manifesting as a progression from single boil-like, pus-filled abscesses, or hard sebaceous lumps, to painful, deep-seated, often inflamed clusters of lesions with chronic seepage (suppuration — hence the name) involving significant scarring.
Causes and Associations:
For unknown reasons, people with hidradenitis develop plugging or clogging of their apocrine glands. This leads to bacterial infection which can produce pain and odor.
Hidradenitis is made worse by being overweight, however this condition is not caused by obesity.
Hidradenitis is more common in people who have had acne.
Hidradenitis may become worse under stress.
Hidradenitis is not caused by poor hygiene.
Hidradenitis is a chronic disease of the apocrine glands (a form of sweat gland found on certain parts of the body). For unknown reasons, people with hidradenitis develop plugging or clogging of their apocrine glands. It causes chronic scarring and pus formation of the underarms (axilla) and groin/inner thigh areas. In women it can also occur under the breasts. It is similar to acne, which is also a disease of the sebaceous glands. Hidradenitis is more common in people who have had acne. It may be an unusual type of adult acne.
This condition is slightly more common in women and African-Americans. Hidradenitis usually starts as one or more red, tender, swellings in the groin or armpits. Over a period of hours to days the lesions enlarge and often open to the skin surface draining clear to yellow fluid. The involved area then heals with scarring. The condition usually continues for years with periods of flare and remission.
Bacterial infection produces the pain and odor. Hidradenitis is made worse by being overweight, however this condition is not caused by obesity and weight loss will improve but not cure hidradenitis. Hidradenitis may become worse under stress. Hidradenitis is not caused by poor hygiene.
Hidradenitis suppurativa usually develops in otherwise healthy people, but it has been associated with Crohn’s disease in some individuals. It is a non-contagious skin disease that usually appears on the body in skin folds of the underarms, groin, or perianal area. It has three main stages, beginning with boils or pockets of infection (abscesses). These become hard, painful, inflamed lumps with drainage (suppuration). Tunnels (sinus tracts) may form around and between the lumps.
Scars form. The last stage is the most debilitating, because large areas of skin are affected by the abscesses, sinus tracts, lumps, and scars.
Worsens over time
Hidradenitis suppurativa usually develops slowly over time, with flare-ups, but in some people the disease progresses quickly. The course of the disease varies for each person. Some will stay at one stage most of the
Topical antibiotics (applied to the skin) are the treatment of choice. Systemic (by mouth) antibiotics are at times necessary when the condition is flaring or when a patient has a severe case.
Tight-fitting clothing is to be strictly avoided.
Dirt does not cause hidradenitis. The involved areas should be cleaned daily using an antibacterial soap, such as the liquid form of Lever 2000. Some patients have found that the liquid form of Lever 2000, applied to the involved areas as a lotion after bathing, can help reduce the odor associated with this condition.
There is no medical cure for hidradenitis. Hidradenitis can be controlled, but not cured. Sometimes surgery is required to drain infected areas or to remove scarred tissue or even large areas of skin.
Weight loss will improve but not cure hidradenitis.
Initial treatments are usually oral antibiotics (minocycline, tetracycline, erythromycin, Augmentin, others) and topical antibiotics (clindamycin or erythromycin). Intralesional injections into the affected places reduce swelling and tenderness within days. Anti-inflammatory pills (Celebrex, Advil, Naprosyn, Alleve, and others) are helpful in addition to the antibiotics, especially if it is a severe case. Some women respond to high estrogen birth control pills (Demulen 1/50 Ortho Novum 1/50) and spironolactone pills.
Tight fitting clothing and shaving the areas are to be strictly avoided. Dirt does not cause hidradenitis. The involved areas should be cleaned daily using an antibacterial soap, as this will reduce any odor associated with this condition. Retin-A cream, a prescription, helps some people. Accutane, a drug for severe acne, offers modest help for moderately bad cases. There is medical control, but not cure for hidradenitis.
Surgery is the most effective treatment for recalcitrant hidradenitis. Aggressive surgery will cure an area of severe, chronic hidradenitis but it has to remove scarred tissue or even large areas of skin. Skin grafts may be needed. Incision (lancing) and draining will reliably help smaller affected areas. Because surgery scars and may have complications, medical treatments are usually tried first.
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