HIDRADENITIS SUPPURATIVA (HS)

 

INTRODUCTION

This long medical term refers to painful, red, tender lumps which may also become secondarily infected and appear under the arm and in the groin. The glands involved in this disease are the apocrine (sweat) glands. The exact cause of the disease is unknown, but many factors are thought to contribute to it, such as hormonal changes and bacterial infection. It is not contagious, not inherited, and not a sign of cancer. The most common site is under the arms. Underarm deodorants may irritate the skin, tend to block the gland openings, and may certainly aggravate the problem. When a small stream is dammed, it quickly becomes polluted. Similarly, the glands which cannot excrete their normal material can quickly become infected and painful. Hidradenitis suppurativa is an uncommon disorder of unknown cause in which boil-like lumps develop in the groin and sometimes under the arms and under the breasts. The lumps can also be found in other areas, such as behind the ears, in the crease of the buttocks and around the genitals. Although a few hundred papers have been written on HS, there seems to be relatively little solid knowledge about it. Although there is no medical proof, HS seems to have been found alongside many disorders that are apparently unrelated, such as Crohn's disease, obesity, Dowling-Degos disease, lymphedema (swelling of the body tissues caused by a build-up of fluid), a form of arthritis, sarcoidosis, Down's Syndrome and the sexually transmitted infection chlamydia. The use of some medicines such as lithium have also been linked. The condition is very slightly more common in women when the affected area is the groin, but there is no difference in occurrences between men and women when infection is under the arms. In a study undertaken in Copenhagen, it was discovered that the disorder may not be as rare as imagined, but that patients are simply not diagnosed with HS. They suggested that there was a 1% chance of developing HS in any given period of 12 months (i.e. In a group of 100 randomly picked people, one person will develop HS within 12 months). The disease involves the apocrine and eccrine (sweat) glands, the sebaceous (oil producing) glands and the hair follicles, although there is some disagreement as to whether the infection starts in the follicles and spreads to the sweat and oil glands, or vice-versa. There are often outbreaks linked with periods in women. It is thought that HS is dependent on the androgen sex hormones. However, the levels of androgens in HS sufferers are usually the same as in non-sufferers, although other disorders linked to androgens, such as acne, are commonly found with HS. The disease often shows itself during puberty, but has appeared as late as post-menopausal age. A bacterium called Streptococcus milleri appears to be a common organism infecting lumps, and it is suggested that a common bacterium that lives on the skin and in the nose, Staphylococcus aureus, plays a part in the early stages of the development of the disease. Bacterial infection was only found in about 50% of swabs taken of the swellings caused by HS. The tendency to develop HS is hereditary, but this does not mean that your children or other relatives will definitely develop HS.

 

IMPORTANT POINTS IN TREATMENT

Activity: Stay in good physical condition by increasing daily exercise. Make your exercise periods fun, if possible, but be sure to exercise daily. A walking or swimming program help. Diet: There are no special restrictions, except that you should lose weight if you are overweight. GENERAL MEASURES-  Do not shave hair from the underarm area. You may cut the hair fairly short with scissors.- Wear lightweight, porous clothing: cotton, if possible.- Stop using all commercial underarm deodorants. You may apply colorless liquid Dial soap frequently. This helps kill bacteria and will also serve as a deodorant.- Bathe frequently with an antiseptic soap.- Apply moist water compresses to the areas involved for 20 minutes, 4 times daily. Use clean, porous cloths folded into several layers. Dip them frequently into plain hot water. - Sometimes,

Dr. Jacobs may recommend surgery if your problem persists. Pus from these areas may be cultured so that the bacteria complicating the disease can be identified and the proper antibiotic can be prescribed. Treatment is difficult and often not as successful as people would like. However, HS can often be controlled using the measures below: It is important to wash the skin with antiseptics to reduce the number of bacteria that live on it. These bacteria usually cause no problems, but can sometimes cause infection if the skin is broken by a cut or scratch, for example. Short courses of antibiotics when a bad flare-up occurs, that is, when the area is red, hot painful and discharging. Dicloxacillin is the most useful at this point, although you may be given a combination of antibiotics until the results of tests reveal exactly what bugs are causing the infection. Lancing of the abscesses at the very painful "pointing" stage to relieve the pressure and most of the pain caused by that pressure. Prolonged course of the antibiotics tetracycline or metronidazole (maximum 3 months at a time) for their ability to reduce the swelling and inflammation. In addition, the metronidazole destroys the bacteria that are anaerobic. These bugs don't need oxygen and in the course of their normal activities produce chemicals that result in the characteristic "sweet" smell of the pus. As a result, this smell is reduced during use of metronidazole. Excision (cutting out) of persistent lumps can work if they are not cleared up after several months of waiting and antibiotics. The combined oral contraceptive pill and/or cyproterone acetate, a chemical that reduces the level of androgens (hormones that are also linked to acne), taken for 12 months or more can help, however, cyproterone acetate is not FDA approved. Retinoids (vitamin - A - like compounds which are very effective for acne) taken for 6 to 12 months. An example of these is isotretinoin (Accutane). Only if the case is very severe will there be radical excision surgery, requiring skin grafts. In addition, there are several other steps that can be taken that may or may not help - you can only find out if you try! Washing inflamed areas with salt water (two or three tablespoons in a pint of water). Tea tree oil in the water when bathing or washing affected areas (this can be bought at health food shops, but make sure it is the pure essential oil). Although the temptation is to wash about 10 times a day, avoid using perfumed and/or block soaps directly on the skin, antiperspirants, deodorants, talc or razors in the affected areas. The same goes for any other product or activity that could irritate or damage the skin surface. Try maintaining your Vitamin C intake, either naturally by eating lots of fruit like oranges or by taking a supplement. Ultraviolet light may help, so try getting some sun on the areas, but be careful with some antibiotics which make the skin more sensitive, and also watch out for the police if the affected area is in the groin!!! When a lump has just burst or been lanced, try keeping it covered with magnesium sulfate paste (drawing ointment) on gauze to draw out the pus as well as protect your clothes. Make sure the dressings are changed at least once a day, but don't go overboard. Try getting air to the areas, as they are often moist, warm and don't get aired that often, which is a perfect environment for bacteria to breed. A lukewarm bath when the lumps are really painful can ease some of the pain and help draw it to a head, and ice packs can numb the area sufficiently to carry on with life. As to painkillers, there are several; Ibuprofen: Reduces inflammation as well as the pain. Ask Dr. Jacobs for blood tests if they haven't already been done - a test for diabetes and a nasal swab to test for Staph. aureus. MEDICATIONS: The medicines must be fitted to your particular needs. Do not take any medicine (not even medicine you buy without prescriptions) without telling Dr. Jacobs. If drugs are prescribed, carefully follow the instructions on the label. NOTIFY OUR OFFICE IF ANY OF THE FOLLOWING HAPPENS- You develop a temperature over 100 degrees F. orally. - The prescribed program and medicines do not bring relief in a week or so.