| Question:
I have recently undergone surgery for
hidradenitis suppurativa. Unfortunately,
I have had a recurrence of the problem.
Is there a way to prevent continued
outbreaks?
Answer:
Hidradenitis suppurativa is primarily
a disease of occlusion (obstruction) and
inflammation of the apocrine (odor)
sweat glands of the groin and axilla (armpit).
It is similar to acne, which is a
disease of the sebaceous (oil) glands in
the skin. Hidradenitis develops when
ducts from the apocrine glands to the
skin surface become blocked, leading to
a red swollen area on the skin and to
the formation of cysts, infection and
scarring.
The cause of this uncommon, chronic,
recurrent infection, which is slightly
more common in African-Americans and
women, is unknown. It is not contagious,
usually starts during puberty, and
sometimes improves during pregnancy.
Heredity probably plays some role, with
severity varying from person to person.
Treatment consists mainly of speeding
the healing of the lesions and lessening
the severity of an outbreak.
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. Sometimes, as in
your case, surgery is required to drain
infected abscesses or to remove scarred
tissue or even large areas of involved
skin.
Hidradenitis is made worse by being
overweight, but it is not caused by
obesity, nor is it caused by poor
hygiene. The condition may become worse
under stress and is more common in
people with diabetes.
Topical antibiotics (applied to the
skin) are the treatment of choice.
Systemic (by mouth) antibiotics are
sometimes necessary, when the condition
is flaring or when an outbreak is
particularly bad. Occasionally,
cortisone-type drugs or the prescription
acne medication Accutane may be helpful.
Liposuction has proven effective for
a limited number of patients.
Liposuction works by "sucking out" the
apocrine glands, along with the
subcutaneous fat in the affected areas.
Women tend to get the condition more
under the arms, and men around the
groins, but there is a great deal of
overlap. Since the germs infecting the
cysts come from the overlying skin
surface, scrupulous skin care is
necessary with antibacterial soaps. Warm
soaks to the armpits or sitz baths for
abscesses forming in the groin area
should be started as soon you feel any
lump or tenderness in the area. Only
non-perfumed deodorants should be used
to avoid any allergic skin reaction that
will increase the likelihood of
infection.
Additional measures that help to
reduce the frequency and intensity of
hidradenitis include:
· Wearing loose-fitting clothing
· Reducing activity that makes you
sweat profusely
· Washing with Tea Tree oil soap may
help reduce the burning and itching
· Losing weight
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