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 that can 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.
Initial treatments is usually oral antibiotics (Minocycline,
Tetracycline, Erythromycin, Augmentin, others) and topical antibiotics (cleocin-T, Emgel, others).
Intralesional injections into
the affected places reduces 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
orthonovum 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, such as the cetaphil
antibacterial or liquid Lever 2000, 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 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.