Hidradenitis Suppurativa: A Chronic Apocrine Disease

Hidradenitis Suppurativa is a chronic skin disease that affects the apocrine sweat glands of the body. Apocrine glands are found in underarms, breast, groin, inner thighs, and buttocks.

This condition is more common in women and African-Americans. The condition starts with one or more red, tender, swellings in areas such as the armpit and groin. Over a period of time, the lesions grow and result to open skin with pus drainage. Bacterial infection is responsible for the pain and odor of this disease.

Hidradenitis suppurativa worsens in overweight individuals but this condition is not caused by obesity. Weight loss will improve the condition but not cure it. Hidradenitis suppurativa maybe caused by stress and is not caused by poor hygiene.

This non contagious disease is characterized by clusters of chronic abscesses, sebaceous cyst, pilonidal cyst and epidermoid cyst. Lesions vary in size and can be extremely painful to touch. Abscesses and cyst can be in a formation of blackheads and red tender bumps that grow bigger, break open, and drain pus.

These manifestations can persist for years with periods of inflammation and drainage of pus leaving open wounds that would not heal. Exacerbations can be triggered by perspiration, hormonal changes, heat, humidity, and friction from clothing. Incision and drainage provide temporary relief from severe pressure pain caused by abscess.

Lesions may lead to scarring and formation of tunnels under the skin. These tunnels will connect different abscess that may lead to further infection. Healing may not be possible at this stage of the disease.

Progression of the disease varies from person to person, with some cases of remission that occur from months to years while others may experience worse symptoms that may require multiple surgeries. Wound dehiscence, which happens as wound separates when it is not supposed to, may happen as a complication of the surgery leading to poor prognosis of healing. Bacterial infection and cellulitis may occur at operated sites. The pain of this disease is difficult to manage.

This condition may go undiagnosed for years. Some medical professionals may misdiagnose the disease because of its rare prevalence. The prescribed treatments for misdiagnosed disease may be ineffective, temporary or harmful to hidradenitis suppurativa.

The cause of the disease is unknown. It is sometimes called the orphan illness due to little research conducted. The incidence rate of this disease is not known because it is considered a rare disease.

Oral antibiotics such as minocycline, tetracycline, erythromycin and augmentin are given for initial treatments together with topical antibiotics such as clindamycin and erythromycin.

Intralesional injections and anti inflammatory medications are given to relieve swelling and tenderness.

Some woman responds to hormonal pills and spirinolactone to resolve symptoms.

One should remember that using tight clothing and shaving are not allowed. The affected area should also be cleaned daily with anti bacterial soap as this will reduce the odor of lesions.

Retin A cream and acutance which are drugs for severe acne offer relief for moderate cases. There is medical control of this condition but not cure.

Surgery on the other hand is the most effective management for this condition. Surgery will involve removal of scarred tissue and large area of skin for drafting. Because of the complications associated with this surgery, medicinal management is usually tried first.

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