Tag Archives: Apocrine sweat gland

Body Oder

Definition & Causes:
Body odor, or B.O., bromhidrosis, osmidrosis and ozochrotia, is a perceived unpleasant smell our bodies can give off when bacteria that live on the skin break down sweat into acids – some say it is the smell of bacteria growing on the body, but it really is the result of bacteria breaking down protein into certain acids.

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Body odor usually becomes evident if measures are not taken when a human reaches puberty – 14-16 years of age in females and 15-17 years of age in males. People who are obese, those who regularly eat spicy foods, as well as individuals with certain medical conditions, such as diabetes, are more susceptible to having body odor…

People who sweat too much – those with hyperhidrosis – may also be susceptible to body odor, however, often the salt level of their sweat is too high for the bacteria to break down – it depends where the excess sweating is occurring and which type of sweat glands are involved.

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.Body odour is caused by a natural process involving sweat that occurs on the skin’s surface. Sweat is odourless, but if left on the skin the bacteria that normally live there feed on it and break it down. This process releases chemicals that cause the unpleasant smell.

Some areas of the skin, such as the armpits and genitals, are more likely to produce body odour because these glands produce proteins and oily substances that bacteria feed on.

The feet produce their own characteristic odour. We tend to wrap them in socks and shoes, making them hot and humid and allowing fungi, as well as bacteria, to flourish.

According to Medilexicon’s medical dictionary:
Bromhidrosis (or bromidrosis) is a “fetid or foul-smelling perspiration. Apocrine bromhidrosis affects the axillae after puberty, and eccrine bromhidrosis is generalized, with excessive sweating.”

Sweat itself is virtually odorless to humans; it is the rapid multiplication of bacteria in the presence of sweat and what they do (break sweat down into acids) that eventually causes the unpleasant smell. The smell is perceived as unpleasant, many believe, because most of us have been brought up to dislike it. Body odor is most likely to occur in our feet, groin, armpits, genitals, pubic hair and other hair, belly button, anus, behind the ears, and to some (lesser) extent on the rest of our skin.

Body odor can have a nice and specific smell to the individual, and can be used – especially by dogs and other animals – to identify people. Each person’s unique body odor can be influenced by diet, gender, health, and medication.

Two types of acid are commonly present when there is body odor:

*Propionic acid (propanoic acid) is commonly found in sweat – propionibacteria break amino acids down into propionic acid. Propionibacteria live in the ducts of the sebaceous glands of adult and adolescent humans. Some people may identify a vinegar-like smell with propionic acid, because it is similar to acetic acid, which gives vinegar its sour taste and pungent smell.

*Isovaleric acid (3-methyl butanoic acid) is another source of body odor as a result of actions of the bacteria Staphylococcus epidermidis, which are also present in several strong cheese types.
Body odor can smell pleasant and specific to the individual and can be used to identify people, though this is more often done by dogs and other animals than by humans. An individual’s body odor is also influenced by diet, lifestyle, gender, genetics, health and medication.

Sweating and our sweat glands:-

The average human body has three to four million sweat glands, of which there are two types:

*Eccrine glands a type of simple sweat gland that is located in almost all areas where there is skin. They produce sweat that reaches the skin’s surface via coiled ducts (tubes). When sweat evaporates from the skin the body is cooled. Eccrine glands are responsible for regulating our body’s temperature.

*Apocrine glands – these glands are found in the breasts, genital area, eyelids, armpits and ear. In the breasts they secrete fat droplets into breast milk. In the ear they help form earwax. Apocrine glands in skin and the eyelids are sweat glands.

Genetics:
Body odor is largely influenced by major histocompatibility complex (MHC) molecules. These are genetically determined and play an important role in immunity of the organism. The vomeronasal organ contains cells sensitive to MHC molecules in a genotype-specific way. Experiments on animals and volunteers have shown that potential sexual partners tend to be perceived more attractive if their MHC composition is substantially different. This behavior pattern promotes variability of the immune system of individuals in the population, thus making the population more robust against new diseases.

One study suggests that body odor is genetically determined by a gene that also codes the type of earwax one has. East Asians (those of Chinese, Japanese, Korean, and Vietnamese descent) have the type of sweat glands that even after hitting puberty still don’t produce the chemicals found in the perspiration of other ancestral groups. East Asians evidently have a greater chance of having the ‘dry’ earwax type and reduced axial sweating and odor. This may be due to adaptation to colder climates.

Why  you should  be aware of it?
Medical research shows that people with body odour might suffer from severe problems in their personal and social relationships. It might also impact their work life — with colleagues and seniors avoiding them. They might not get full rewards of their hard work which in turn might wreck promotion prospects at work. For kids it might lead to educational under-achievement because of teasing and bullying along with enormous degrees of stress which is blamed for their frequent progression into alcoholism, excessive tobacco or drug use and in some cases to suicide.

Feelings of shame, embarrassment, low self-esteem, isolation, frustration, anxiety and depression are extremely common where body odour is present.

Although sufferers and their families have been shown to gain considerable benefit from sympathetic counseling, and while learning to deal with the stress this condition causes is certainly important – long-term strategies and approaches which deal with underlying causes of increased body odour are probably a lot more important.

It is important to know how to deal with the problem of body odour if you are suffering from it. If someone in your personal, social or professional circle suffers from body odour then there is a need to find out a way to address the issue mindfuly and delicately to avoid future embarassment to the person.

 

Symptoms:
The symptom is an unpleasant smell that may be worse in hot and sweaty conditions. The actual smell varies from person to person. The ‘recipe’ of sweat is individual.

Body odour may be influenced by diet. Certain foods, such as curry, garlic and strong spices, contain chemicals that may be excreted in the skin.

The smell almost always disappears with a shower or bath, but can return rapidly, especially if a person puts on unwashed clothes covered in old sweat and bacteria.

 

Diagnosis:
In the vast majority of cases of body odor it is not necessary to see your doctor. The individual himself/herself may be aware of it, or a good friend or a member of the household may tell them about their body odor. There are some self-care techniques that will usually successfully treat the problem.
Most people can easily recognise body odour. Unfortunately, the person who has it may be so accustomed to their own smell that they don’t notice.

When to see your doctor:
Some medical conditions may change how much a person sweats, while others can alter how we sweat, subsequently changing the way we smell. For example, hyperthyroidism (an over-active thyroid gland) or the menopause can make people sweat much more, while liver disease, kidney disease, or diabetes can change the consistency of sweat so that the person smells differently. You should see your doctor if:

*You start sweating at night

*You start sweating much more than you normally do, without any logical reason

*You have cold sweats

*Sweating disrupts your daily routine

*You body smells differently – if it is a fruity smell it could be due to diabetes, liver or kidney disease often makes the individual have a bleach-like smell.

Treatment:
#.Armpits – a large concentration of apocrine glands exist in the armpits, making that area susceptible to rapid development of body odor.

*Keep the armpits clean – wash them regularly using anti-bacterial soap, and the number of bacteria will be kept low, resulting in less body odor.

*Hair under the armpits slows down the evaporation of sweat, giving the bacteria more time to break it down into smelly substances; shaving the armpits regularly has been found to help body odor control in that area.

*Deodorant or antiperspirant – deodorants make the skin more acidic, making the environment more difficult for bacteria to thrive. An antiperspirant blocks the sweating action of the glands, resulting in less sweating. Some studies, however, have indicated that antiperspirants may be linked to breast cancer or prostate cancer risk; this study suggests that the evidence is inconclusive either way.

*Botulinum toxin – this is a toxin produced by Clostridium botulinum; it is the most poisonous biological substance known. However, very small and controlled doses are today being used in various fields of medicine. A relatively new treatment is available for individuals who sweat excessibely under the arms.

The patient is given approximately 12 injections of botulinum toxin in the armpits – a procedure that should not last more than 45 minutes. The toxin blocks the signals from the brain to the sweat glands, resulting in less sweating in the targeted area. One treatment can last from two to eight months. In countries where free universal healthcare is available, such as the NHS (National Health Service), UK, botulinum toxin therapy for excessive underarm sweating is not usually available and most patients will have to do it privately (pay for this specific treatment).

#.Wash daily with warm water – have a shower or bath at least once a day. Remember that warm water helps kill off bacteria that are present on your skin. If the weather is exceptionally hot, consider bathing more often than once a day.

#Clothing – natural fibers allow your skin to breathe, resulting in better evaporation of sweat. Natural-made fibers include wool, silk or cotton.

#Spicy foods – curry, garlic and some other spicy (piquant) foods have the potential to make some people’s sweat more pungent. Some experts believe a diet high in red meat may also raise the risk of developing more rapid body odor.

#Aluminum chloride – this substance is usually the main active ingredient in antiperspirants. If your body does not respond to the home remedies mentioned above, talk to a pharmacist or your doctor about a suitable product containing aluminum chloride. Follow the instructions given to you carefully.

#Treatment for smelly feet (bromodosis) – smelly feet are less of a problem socially than underarm B.O. because the unpleasant odor is usually contained by shoes and socks. However, the smell may become obvious if the person with smelly feet visits a home where shoes are taken off before entering, as is the custom in various countries and homes. The following steps may help control food odor:

*Wash your feet in warm water regularly – this means at least once a day. Remember that warm water is better at killing off bacteria than cold water. Tea-tree oil, when added to water, helps kill off bacteria (do not apply tea-tree oil directly to skin). Make sure you dry your feet thoroughly afterwards, including in between your toes.

*Socks – they must allow the sweat to evaporate. The best socks are those made of a combination of man-made fibers and wool. Wear a clean pair of socks each day.

*Shoes – if you wear trainers or shoes with plastic linings make sure it is not for long. A leather lining is better for sweat evaporation. If you have a problem with sweaty feet, do not wear the same pair of shoes two days in a row – shoes do not completely dry overnight.

*Pumice stone – bacteria thrive on dead skin. If the soles of your feet have patches of dead skin remove them with a pumice stone.

*Deodorants and antiperspirants – ask your pharmacist for special foot deodorants and antiperspirants. If you have athlete’s foot you should not use deodorants or antiperspirants – treat the fungal infection first with appropriate medication.

*Go around barefoot – whenever you can walk around barefoot, or at least slip out of your shoes regularly.

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*Home Remedies for Body Odor
*7 Tips To Manage Body Odour
*Home Remedy for Body Odor & Herbal Care   :

 

 

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/bodyodour2.shtml
http://www.medicalnewstoday.com/articles/173478.php
http://en.wikipedia.org/wiki/Body_odor

http://www.copperwiki.org/images/c/c7/Odor.jpg

http://www.copperwiki.org/index.php/Body_Odour

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Hidradenitis Suppurativa

Definition:
Hidradenitis suppurativa or HS is a skin disease that affects areas bearing apocrine sweat glands and hair follicles; such as the underarms, groin and buttocks. It is more commonly found in women and can be present under the breasts.

Hidradenitis suppurativa is a chronic skin inflammation marked by the presence of blackheads and one or more red, tender bumps (lesions). The lesions often enlarge, break open and drain pus. Scarring may result after several occurrences.

The cause of hidradenitis suppurativa isn’t known. But it’s considered a severe form of acne (acne inversa) because it occurs deep in the skin around oil (sebaceous) glands and hair follicles. The parts of the body affected — the groin and armpits, for example — are also the main locations of apocrine sweat glands.

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Hidradenitis suppurativa tends to start after puberty, persist for years and worsen over time. There is no cure for hidradenitis suppurativa. But early diagnosis and treatment can help manage the symptoms and prevent new lesions from developing.

Other names for HS
Hidradenitis suppurativa has been referred to by multiple names in the literature, as well as in various cultures. Some of these are also used to describe different diseases, or specific instances of this disease.

*Acne conglobata – not really a synonym – this is a similar process but in classic acne areas of chest and back

*Acne Inversa (AI) – a new term which has not found favour.

*Apocrine Acne – a misnomer, out-dated, based on the disproven concept that apocrine glands are primarily involved

*Apocrinitis – another misnomer, out-dated, based on the disproven concept that apocrine glands are primarily involved

*Fox-den disease – a catchy term not used in medical literature, based on the deep fox den / burrow – like sinuses

*Hidradenitis Supportiva – a misspelling

*Pyodermia sinifica fistulans – an older term, considered archaic now, misspelled here

*Velpeau’s disease – commemorating the French surgeon who first described the disease in 1833

*Verneuil’s disease – recognizing the French surgeon whose name is most often associated with the disorder as a result of his 1854-1865 studies

Stages
HS presents itself in three stages.

1.Solitary or multiple isolated abscess formation without scarring or sinus tracts. (A few minor sites with rare inflammation; may be mistaken for acne.)

2.Recurrent abscesses, single or multiple widely separated lesions, with sinus tract formation. (Frequent inflammations restrict movement and may require minor surgery such as incision and drainage.)

3.Diffuse or broad involvement across a regional area with multiple interconnected sinus tracts and abscesses. (Inflammation of sites to the size of golf balls, or sometimes baseballs; scarring develops, including subcutaneous tracts of infection – see fistula. Obviously, patients at this stage may be unable to function.)
Sign and Symptoms:

Hidradenitis suppurativa commonly occurs around hair follicles where many oil and sweat glands are found, such as the armpits, groin and anal area. It may also occur in areas where skin rubs together, such as the inner thighs, under the breasts or between the buttocks. Hidradenitis suppurativa can affect a single area or multiple areas of the body.

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Hidradenitis suppurativa usually appears as one or more red, tender bumps that fill with pus. It commonly occurs where oil (sebaceous) and apocrine sweat glands are found, such as the armpits, groin and anal area.

 

Signs and symptoms of hidradenitis suppurativa include:

*Small pitted areas of skin containing blackheads, often appearing in pairs or a “double-barrel” pattern.

*One or more red, tender bumps (lesions) that fill with pus. The bumps often enlarge, break open and drain pus. The drainage may have an unpleasant odor. Itching, burning and excessive sweating may accompany the bumps.

*Painful, pea-sized lumps that grow under the skin. These hard lumps, which may persist for years, can enlarge and become inflamed.

*Painful bumps or sores that continually leak fluid. These open wounds heal very slowly, if at all, often leading to scarring and the development of tunnels under the skin.

For some people, the disease progressively worsens and affects multiple areas of their body. Other people experience only mild symptoms. Excess weight, stress, hormonal changes, heat or excessive perspiration can worsen symptoms.

Causes:
Hidradenitis suppurativa develops when the oil glands and hair follicle openings become blocked. When oils and other skin products become trapped, they push into surrounding tissue. Bacteria can then trigger infection and inflammation. It’s not known why this occurs, but a number of factors — including hormones, genetics, cigarette smoking and excess weight — may all play a role.

Sometimes hidradenitis suppurativa occurs with other diseases, such as Crohn’s disease, herpes simplex or Grave’s disease.

As this disease is poorly studied, the causes are controversial and experts disagree. However, potential indicators include:

*post-pubescent

*females are more likely than males

*genetic predisposition

*plugged apocrine (sweat) gland or hair follicle

*excessive sweating

*bacterial infection

*sometimes linked with other auto-immune conditions

*androgen dysfunction

*genetic disorders that alter cell structure

*stress can bring on outbreaks

*being overweight makes it worse, however this condition is not caused by obesity and weight loss will improve but not cure it.

*cigarette smoking tends to encourage outbreaks as well

The historical understanding of the disease is that there is a misfunction in either the apocrine glands or hair follicles, possibly triggered by a blocked gland, creating inflammation, pain, and a swollen lesion. More recent studies imply there is an autoimmune component.

HS is not caused by any bacterial infection — any infection is secondary. Most cultures done on HS lesions come back negative for bacteria, so antibiotics should be used only when a bacterial infection has been confirmed by a physician.

Hidradenitis suppurativa is not contagious.

Screening and Diagnosis:
To make a diagnosis, your doctor may ask about your symptoms and medical history, examine your skin, and order blood tests. If pus or drainage is present, your doctor may send a sample of the fluid to a laboratory for testing. This test is known as a culture. Such tests may be necessary to rule out other skin conditions, such as tuberculosis of the skin, a carbuncle or a pilonidal cyst.
General Complications:
Hidradenitis suppurativa often causes complications when the disease is persistent and severe. These complications include:

*Sinus tracts or tunnels that connect and form a network under the skin. The tracts prevent the sores from healing and cause more sores to develop.

*Scars and skin changes. Severe hidradenitis suppurativa may leave thick, raised scars, pitted skin or patches of skin that are darker than normal (hyperpigmentation).

*Restricted movement. The disease may cause limited or painful movement, especially when it affects the armpits or thighs.

*Cellulitis. This potentially serious bacterial infection appears as an area of swollen, red skin that feels hot and tender and that may spread rapidly. Although the initial infection may be superficial, it eventually can affect the tissues underlying your skin or spread to your lymph nodes and bloodstream.

Severe complications:
Left undiscovered, undiagnosed, or untreated, the fistulas from severe stage-3 HS can lead to the development of squamous cell carcinoma in the anus or other affected areas.

Treatments:

There is no cure for hidradenitis suppurativa. But early treatment can help manage the symptoms and prevent new lesions from developing.
Treatments may vary depending upon presentation and severity of the disease. Due to the poorly-studied nature of this disease, the effectiveness of the drugs and therapies listed below is not yet clear, and patients should discuss all options with their doctor or dermatologist. Nearly a quarter of patients state that nothing relieves their symptoms. A list of treatments that are possible treatments for some patients is as follows.

*lifestyle

*changes in diet.

*warm compresses, baths (to induce drainage)
medication
*ntralesional corticosteroid injections (to reduce inflammation)

*oral antibiotics (to treat inflammation and bacterial infection)

*isotretinoin (Accutane), a prescription-only oral acne treatment (benefits for HS are very controversial, but it is generally considered to be ineffective)

*anti-androgen therapy

*sub-cutaneous injection or IV infusion of anti-inflammatory (anti-TNF-alpha) drugs such as infliximab (Remicade), etanercept (Enbrel), and adalimumab. This use of the drugs is not currently Food and Drug Administration (FDA) approved and is

*somewhat controversial, and therefore may not be covered by insurance.
Acitretin

*Zinc gluconate taken orally has been shown to induce remission
surgery (But Obesity, incomplete removal and ongoing skin infections can increase the chances that hidradenitis suppurativa returns, even after surgical treatment.)

*incision and drainage or lancing

*wide local excision (with or without skin grafting), or laser surgery

*radiotherapy

Self-care:
The following suggestions may help relieve discomfort, speed healing and prevent the infection from spreading:

*Apply a warm washcloth or compress to help reduce swelling.

*Gently wash the affected areas with antibacterial soap. After washing, apply an over-the-counter antibiotic.

*Wear loosefitting clothes and underwear to prevent skin irritation.

*Avoid shaving the affected areas to prevent skin irritation.

*Don’t smoke. Smoking can worsen symptoms and trigger new outbreaks.

Excess weight increases the number of areas where skin rubs together — for example, between skin folds — causing friction, increased perspiration and bacterial growth. Though weight loss won’t cure the disease, it may improve symptoms.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://en.wikipedia.org/wiki/Hidradenitis_suppurativa
http://www.mayoclinic.com/health/hidradenitis-suppurativa/DS00818/DSECTION

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Hindradenitis Suppurative

Definition:
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.

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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.

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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.

Symptoms
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

Treatment:

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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Homeopathy & Hidradenitis Suppurativa

Click Here for Medical and Research Articles on Hidradenitis Suppurativa

Resources:
http://www.skinsite.com/info_hidradenitis_suppurativa.htm
http://www.aocd.org/skin/dermatologic_diseases/hidradenitis_suppu.html
http://www.hs-usa.org/hidradenitis_suppurativa.htm

http://rarediseases.about.com/cs/hidradenitissupp/a/072703.htm

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