Hidradenitis suppurativa is a painful, progressive, poorly understood skin condition that affects the skin where the apocrine sweat glands are found. The apocrine glands originate where the skin meets subcutaneous fatty tissue. They secrete fluids that aren't just "sweat," but that include fatty acids and proteins. The glands affected by hidradenitis suppurativa are on your groin, under your armpits, around your nipples, and sometimes at your tear ducts. The disease can cause lesions where they are not expected.
Skin lesions in this disease look like common acne at first. The sores weep and heal over with scar tissue, and then break out again. They aren't caused by infection, although they can become infected. They are painful, they are red, and they can cause rope-like elevation of the skin. Eventually, the "ropes" of inflamed skin can grow to meet each other. The spread of the disease may involve inflammation of hair follicles rather than sweat glands. There will be more than one lesion, and the outbreak tends to concentrate on the "milk line," the breasts and under the arms.
Medical science doesn't know what causes hidreadenitis suppurativa, so there's no blood test or biopsy for it. The diagnosis is made on the basis of observing the skin. The location of the outbreak is the essential clue. The absence of infection is another. Significant pain also points to hidreadenitis. Doctors will rule out cat scratch infections, fungal infections, and erysipelas (a bacterial infection of the skin) before they make a diagnosis of hidreadenitis suppurativa.
What can you do about this condition?
- Bathing and swimming relieve inflammation.
- Avoiding hot and sweaty conditions, staying close to the air conditioner in hot and humid weather, will reduce outbreaks.
- Deodorants increase outbreaks. Avoid them.
- Shaving body hair can set off the formation of cysts, as can using depilatories (hair removal products). However, laser hair removal can be useful.
- If you are obese, it helps to lose weight, losing enough weight that you "look" thinner because of the reduction of fat layers beneath your skin. Reducing subcutaneous fat reduces that activity of the glands that cause the inflammation.
- If you are hairy, laser hair removal reduces the opportunities for the disease to spread across your body through inflamed hair follicles or ingrown hairs.
- Wearing loose-fitting clothes reduces irritation that can cause the formation of cysts at hair follicles.
- Keeping dry preserves the integrity of the skin. If you have hyperhidrosis, you may need to avoid aluminum-based antiperspirants. They reduce sweat, but they also irritate the skin. For you, surgical intervention or laser therapy may be what your doctor prescribes.
- Smoking seems to aggravate hidradenitis suppurativa. Smoking cessation may improve it.
There are medications that may improve symptoms. Even if your lesions from hidradenitis suppurativa are not infected, you may benefit from antibiotics that reduce inflammation. There are medications that reduce the effects of testosterone on your skin so that it grows more slowly and new lesions form more slowsly. These drugs include triamcinolone, spironolactone, and finasteride.
The sad fact is, unfortunately, that most people who have this condition don't find that any single intervention like those listed above makes a significant difference. For them, the next step is surgery to remove the affected glands. Even when apocrine glands are surgically removed, however, the lesions come back about 33 percent of the time. And any surgery only helps relieve the condition in the region of skin that is surgically treated.
There are some newer methods that are less painful than traditional excision with scalpel. These include a technique called exteriorization, draining the affected glands, Nd:YAG laser treatment, scanner-assisted carbon dioxide laser treatment that removes only the abnormal tissue, skin grafts, "deroofing" the tracts that connection lesions across previously healthy skin, and Skin-Tissue sparing Excision with Electrosurgical Peeling (STEEP). These are techniques that your doctor can explain to you.
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