Skin Disorders

Skin disorders cover a wide range of conditions, some benign, some very serious, and some even a sign of another underlying illness. A skin disorder not only affects your physical health, but also your emotional well-being.

SkinCare › Skin Disorders › Hidradenitis Suppurativa

Hidradenitis Suppurativa - Research with (Pictures)

Hidradenitis suppurativa is a chronic, suppurative, often cicatricial disease of apocrine gland-bearing skin in the axillae, the anogenital region, and rarely, the scalp (called cicatrizing perifolliculitis). Sometimes the disease is associated with severe nodulocystic acne and pilonidal sinuses (termed follicular occlusion syndrome).

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.

Causes of Hidradenitis Suppurativa

The causes is unknown. The following sequence may be the mechanism of the development of the lesions: keratinous plugging of the apocrine duct › dilatation of the apocrine duct and hair follicle › severe inflammatory changes limited to a single apocrine gland › bacterial growth in dilated duct › ruptured duct/gland resulting in extension of inflammation/infection › extension of suppuration/tissue destruction › ulceration and fibrosis, sinus tract formation

Signs and symptoms of Hidradenitis Suppurativa

Symptoms: Intermittent pain and marked point tenderness related to abscess formation in axilla(e) and/or anogenital area.

Skin Lesions - Initial lesion: very tender, red inflammatory nodule/abscess that may resolve or point to surface and drain purulent/seropurulent material; relationship to hair follicle usually not apparent. The same lesion may appear repeatedly in the same location and therefore can be surgically excised Eventually, sinus tracts may form. Fibrosis, "bridge" scars, hypertrophic and keloidal scars contractures. Open comedones, and at times unique double comedones, form ; and these are highly characteristic of the disease. Double comedones, with two adjaceut black comedones, may be present even whet, active nodules are absent, and these are a marker for a patient with hidradenitis suppurativa. Rarely, lymphedema of the associated limb may develop. Lesions moderately to exquisitely tender. Pus drains from opening of abscess and sinus tracts

Three distinct clinical stages have been defined for the condition.

• Stage 1 - solitary or multiple, isolated abscess formation without scarring or sinus tracts
• Stage 2 - recurrent abscesses, single or multiple widely separated lesions, with sinus tract formation
• Stage 3 - diffuse or broad involvement, with multiple interconnected sinus tracts and abscesses.

Disease may spread to involve less commonly associated sites including the nape of the neck, waistband and inner thighs. Anogenital involvement most commonly affects the groin, mons pubis, vulva, sides of the scrotum, perineum, buttocks and perianal folds. The abscesses and sinus tracts can be painful.

Hidradenitis Suppurativa Diagnosis

If you have more than three boils in any one year, you should visit your Medical Practitioner. Boils can be a symptom of many illnesses and your doctor should test you for these. The diagnosis of Hidradenitis Suppurativa generally comes from the dermatologist, and is made from observing the areas where the boil-like lesion are, and the common presence of black heads and scarring. It is easily diagnosed if the dermatologist is familiar with the skin disorder.

Treatment for Hidradenitis Suppurativa

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.

Surgical Management

• Incise and drain acute abscesses.
• Excise chronic recurrent, fibrotic nodules or sinus tracts. If one or two nodules can be pin­pointed with recurrent disease, they can be, excised with a good result.
• With extensive, chronic disease, complete excision of axilla or involved anogenital area may be required. Excision should extend down to fascia and requires split skin grafting.
• Radical excisional surgery is reserved for very severe cases of hidradenitis suppurativa.

Psychologic Management

These patients need constant reassurance, as they become very depressed because of the nature of the illness and the site of occurrence (anogenital area). Therefore, every effort should be made to deal with the disease, using every modality possible.

Tips on preventing and treating Hidradenitis Suppurativa

• If you are too heavy, you will need to lose weight.
• As with many other diseases in skin folds, friction makes hidradenitis suppurativa worse, and should be avoided. 
• Hot packs applied to swelling
• You should wash with antiseptic soaps or bath additives.
• Tight fitting clothing and shaving the areas are to be strictly avoided.