Hidradenitis Suppurativa - Symptoms and Treatment

The hidradenitis suppurativa, also known as reverse hidrosadenitis or acne, is a chronic inflammatory skin disease, characterized by subcutaneous inflammatory nodules, which are often mistakenly diagnosed as boils or pimples large.

Hidradenitis suppurativa
Hidradenitis suppurativa

What is hidradenitis suppurativa

The hidradenitis is a disease that until recently was thought to have originated in the apocrine sweat glands, which are producing glands of a type more greasy sweat, which drain into a hair follicle.

Inflamed hair shaft
Inflamed hair shaft
The most widely accepted theory states that illness arises due to a blockage of the hair follicle, which leads to accumulation of sebum and sweat, and consequently, inflammation in the area. Often the high pressure within the follicle leads to rupture, promoting bacterial contamination and the formation of small tunnels in the deeper skin layers.

Unlike boil, hidradenitis can become a chronic, lasting weeks to months. Recurrence is also extremely common, causing the same skin site is affected by hidradenitis dozens of times during the life.

The hidradenitis suppurativa is a disease that affects more women than men and is more common in adolescents and young adults. This disease is also more common in obese people (or overweight), smokers and those with family history of hidradenitis.

Symptoms of hidradenitis suppurativa

The hidradenitis is a disease that mainly affects areas intertriginous, or regions where two skin surfaces come in contact, may suffer friction, such as the armpits, groin, lower part of the breasts or buttocks, around the anus, scrotum or on the inside of the thighs. Axilla and groin are the most commonly affected sites.

Most often, the first injury that arises is a lonely and painful inflamed nodule, measuring about 0.5 to 2.0 cm in diameter. Over time, other satellite nodes can arise around. Lesions with black dots, like blackheads are common around the hidradenitis injuries.

These lumps are usually very painful and can last several days or months. At this stage, hidradenitis often under-diagnosed because most people confuse with "internal spine" or "boil without the head of pus". Unlike the boil, hidradenitis has a more insidious onset, growing more slowly.

After a variable period of time, which may be a few days to several weeks, painful nodules progresses to form an abscess, you can drain to the surface of spontaneously skin or as a result of manipulation of the patient injury . To "burst" the lump of hidradenitis drains one purulent and / or bloody material. The pain often improves after draining.

Not all nodes need to be drained to regress, some involute spontaneously after a few days. In general, the lump disappears or is drained off, but returns after a few weeks or months in the same location. The patient with hidradenitis often reports a history of several injuries that come and go over years, often at the same skin sites.

When the lesions are multiple, they become repetitive or take too long to disappear, forming tunnels or channels in the skin is possible to communicate with each other and with the outside, draining intermittently one purulent and foul-smelling material.

Scars may arise after the resolution of very inflamed lesions. Scarring lesions may be large, and multiple fulfilled. They are frequent in the groin and armpit. severe scarring in the armpit can cause reduced mobility of the arm or lymphatic obstruction, leading to lymphedema (arm swelling of lymph accumulation).

The suppurative hidroadenite can have a significant impact on quality of life of the patient. The unpredictable discharge of purulent material and the odor that accompanies it can be embarrassing. As a result, patients tend to experience social isolation, depression, close relationships and even professional difficulties.

Stages of hidradenitis

The hidradenitis suppurativa usually classified into three groups of disease severity:
  • Stage I - single or multiple abscess formation, but without the formation of channels, tunnels or scars.
  • Stage II - recurrent abscesses, forming channels, tunnels or scars. It is still possible to identify lesions.
  • Stage III - diffuse involvement of the affected skin area, with multiple injuries, several interconnected tunnels and extensive scarring.

About 70% of patients develop only stage I. Fortunately, only 5% of patients arrive at stage III, which is cosmetically disfiguring.

Differences between hidradenitis and furuncle

Hidradenitis suppurativa can be easily confused with a boil, especially at stage I. However, with time, the distinction becomes easy. Boils are not injuries that often turn in the same place, have no preference for intertriginous areas, do not have the nails to yours, do not create tunnels or channels or form large and long scars.

Treatment of hidradenitis suppurativa

There is no definitive cure for hidradenitis suppurativa. But early treatment with a dermatologist can help control symptoms, prevent further damage and prevent scarring.

Some non-drug measures help in the treatment of hidradenitis. The main one is to avoid smoking. Excessive consumption of dairy products and foods high in sugar also appear to be harmful to those with the disease. In patients with overweight, weight loss is essential. Daily hygiene of the affected site is needed and antibacterial soaps can be used.

In patients with stage I hidradenitis, topical antibiotics such as clindamycin 1% solution for direct application to the injury, are normally indicated. corticoids application by puncturing needle injuries is another option, as it helps to speed up the resolution of the same.

In cases of hidradenitis stage II, oral antibiotics, such as doxycycline, to be used by at least 2 or 3 months. Medicines that decrease the action of androgens (male hormones) are effective, especially in women. The options are the Acetat cyproterone associated with estrogen, birth control pills containing ethinyl estradiol and norgestrel or spironolactone. In men, finasteride or dutasteride, two drugs commonly used in benign prostatic hyperplasia may be used to control hidradenitis.

In patients with scars and canals, plastic surgery for removing them may be indicated if the patient's wishes.

In patients with hidradenitis in stage III, a drug called infliximab is the first-line treatment. Isotretinoin (Roaccutane) widely used in severe acne can help improve hidradenitis, but your answer is better in less severe cases.

If hidradenitis not improve with any medical treatment, surgery to remove the scarred skin follicles and patients should be made, being skinned replaced by grafts.

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