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Hidradenitis

Mon 01 Feb 2016 22:44:00 +0200

Hidradenitis suppurativa causes you to get painful bumps under your skin near some of your sweat glands. There's no cure, but treatments and lifestyle changes can bring some relief and cut down on flare-ups. The sweat glands that cause you problems are called apocrine glands. They're located where you have hair, such as under your arms, in the groin, and between the buttocks. But you can also get outbreaks in places where your skin rubs together, such as between your thighs or, for women, under the breasts. The bumps can get infected. When that happens, pockets form under the skin and fill with pus that smells bad when they break open. They can leave scars, too. To keep new bumps from forming, get treatment as soon as you can.

Hidradenitis Suppurativa

Mon 01 Feb 2016 20:55:00 +0200

Hidradenitis suppurativa is a chronic, scarring disease that affects the apocrine, or sweat glands. It is a common skin condition but is frequently misdiagnosed. Hidradenitis suppurativa does not occur before puberty. Most people are between 20 to 40 years old when they develop hidradenitis suppurativa. It can be a disabling and distressing skin condition.

The exact cause of hidradenitis suppurativa is disputed. Because it looks similar to acne, some investigators believe that it is caused by the formation of keratin plugs in the follicles. Because hidradenitis suppurativa occurs in areas that contain apocrine, or sweat, glands, other investigators believe that it is caused by a blockage of the apocrine gland. In either case, the plugged gland or follicle becomes larger, ruptures, and becomes infected. Obesity and cigarette smoking may be triggering factors.

Hidradenitis suppurativa occurs in areas of the body that contain sweat glands including the armpits, groin, buttocks, scalp, and under the female breast. When the condition is mild it may only present as a cluster of 2 or 3 blackheads that communicate under the skin. Once the disease begins, it gets progressively worse. The extensive, deep inflammation leads to painful abscesses. These heal incompletely and cause cord-like scars on the skin. The infection can progress under the skin in tracts linking the abscesses. These boils can be very painful and restrict movement of the affected area.

Hidradenitis suppurativa is diagnosed clinically based on its appearance. There are no lab tests or biopsies that establish the diagnosis. In the early stages, it can be misdiagnosed as an isolated boils. Many people are embarrassed by the multiple infections thinking they are ingrown hairs in sensitive areas. They do not go to the health care provider until the boils have become numerous or intolerable.

Hidradenitis Groin

Mon 01 Feb 2016 20:55:00 +0200

Hidradenitis suppurativa is a disease that usually begins as pimple-like bumps on the skin. The pimple-like bumps tend to develop in places that everyday pimples do not appear. HS is most common on the underarms and groin.

Some people say that their hidradenitis suppurativa looks like one of these skin conditions: Pimples Deep-acne like cysts and blackheads Folliculitis (looks like swollen pimple with a hair in the center) Boils

Getting treatment for hidradenitis suppurativa is important. Early diagnosis and treatment can prevent hidradenitis suppurativa from worsening. If HS worsens, the pimple-like bumps can grow deep into the skin and become painful. They can rupture, leaking bloodstained pus onto clothing. This fluid often has a foul odor.

As the deep bumps heal, scars can form. Some people develop tunnel-like tracts under their skin. As the skin continues to heal and scar, the scars thicken. When thick scars form in the underarm, moving the arm can be difficult. Thick scars in the groin area can make walking difficult. Because hidradenitis suppurativa can look lot like acne, folliculitis, or boils, it is best to see a dermatologist for a diagnosis. To a dermatologist’s trained eye, the differences between hidradenitis suppurativa and other skin diseases are subtle but obvious. Proper treatment depends on an accurate diagnosis.

Axillary Hidradenitis

Mon 01 Feb 2016 20:55:00 +0200

Hidradenitis is a chronic inflammatory skin disease characterized by recurrent nodules and abscesses, typically of apocrine gland-bearing skin. Lesions can progress to sinus tracts and fistulae, and, when healed, can lead to severe scarring and fibrosis. It typically occurs in the groin, inframammary, and axillary regions. It has long been thought of as a disease of the apocrine glands, but more recent literature indicates the etiology to be follicular obstruction. Keratinous plugging of the hair follicle causes dilation of the follicle and eventual rupture. Follicular contents are extruded into the surrounding tissue, which triggers an acute local inflammatory response. Bacteria, if trapped in the follicle, are released as well, and superinfection may be present. However, the role of bacterial infection is controversial as cultures are often sterile, and antibiotics are not always effective. The defect appears to be inherent to the hair follicle, which explains the chronicity and relapsing nature of the disease. Age of onset is typically in the twenties, and the disease tends to wane over the course of 20 years or so with complete cessation in many cases.

Risk factors for hidradenitis are not completely understood but include obesity, smoking, and genetics. Hyperandrogenism had once been thought to play a role, but evidence to support this is conflicting. Obesity is thought to exacerbate the disease process through shearing forces, hormone imbalance, and increased skin surface area. It is also associated with increased levels of circulating cytokines, which contributes to the overall inflammatory process of hidradenitis.

Cigarette smoking appears to play a role although specific causative factors remain to be seen. Nicotine initially stimulates eccrine sweat glands but eventually inhibits glandular function, which may contribute to follicular clogging. It also induces expression of cytokines and stimulates chemotaxis of neutrophils.

Hidradenitis is likely multifactorial, but there is evidence suggesting an autosomal dominant form of the disease. The transmission rate in one study was less than 50%, which would be expected in autosomal dominant inheritance; the authors postulated incomplete penetrance of the gene. Chromosomes 6, 19, and 1 have been associated with hidradenitis, but they cannot account for all cases.

There are currently no established medical therapies to treat active disease and prevent recurrence. Immunosuppressants and antibiotics have limited efficacy. Surgical treatment varies for different stages of the disease. Abscesses should be drained, packed, and left open to avoid closing a possibly contaminated wound. Sinus tracts require unroofing and aggressive exploration of the base as there may be additional tracts. For larger areas of disease, extensive local excision is best. Areas of both active and chronic disease must be removed. Sinus tracts often have visible granulomatous disease that need to be excised. Options for coverage include skin grafting, local transposition flaps, and rarely, pedicled flaps or free tissue transfer. Alternatively, wounds can be left to heal by secondary intention, which often works well.