Follicle Disorders

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Overview

Hidradenitis suppurativa is a potentially serious, chronic, pus-producing (suppurative) disorder of the follicles and sweat glands. Hidradenitis suppurativa develops primarily in the sweat glands located in the armpits, in the groin, around the breasts, and in the anal region.

The follicles and ducts become blocked, and bacteria and pus are forced into the surrounding tissue, causing irritation. Abscesses form and can become quite large and eventually break through the skin. Abscesses may open and drain spontaneously. Scar tissue forms in the healing process. Hidradenitis suppurativa can be a socially and physically painful and disabling disease.

Causes and Risk Factors

The bacterium Staphylococcus aureus is usually involved in the condition, and Proteus species are often involved in chronic cases. Bacteria called coagulase-negative staphylococci (CNS) have also been associated with these infections.

There seems to be a genetic predisposition for the disease, and it seems to be more common in women. Hidradenitis suppurative does not appear in people who have not reached puberty because the sweat glands are not active, but it can appear at any age afterward.

Hidradenitis suppurativa affects people who are extremely overweight (obese) at a higher rate than the general population. Cigarette smokers also have a higher incidence of this disorder than nonsmokers. Researchers have not yet found the connection.

Signs and Symptoms

Signs of this disease are firm red nodules that are usually located under the arm, in the groin, around the breasts, or around the anus. Pustules and abscesses may discharge pus spontaneously and heal slowly, resulting in scar tissue. The appearance of nodules recurs periodically throughout the year. Heat, perspiration, and being overweight can aggravate the condition.

Pain is a common symptom in chronic disease. Over time, fibers of scar tissue branch out, creating restrictive, tight skin. This can interfere with movement of the arms or legs, if the sweat glands in the armpits or groin are involved.

Dermatologists diagnose the disorder by the appearance and location of the lesions.

Complications
Infection and inflammation can spread beyond the sweat glands into cells located in the deep layers of the skin and in muscle tissue. This condition is called cellulitis. The skin covering the infected area is usually warm and tender.

Treatment

Hidradenitis suppurativa is very difficult to treat. For mild to moderate cases, dermatologists first attempt therapy topically, such as with benzoyl peroxide and a topical retinoid. Simple cases can be treated with moist heat or incision and drainage of the abscesses. In more serious cases, oral antibiotics are prescribed. Accutane® (see Acne) can be effective in more difficult cases of hidradenitis suppurativa. However, it must be taken in much higher doses than when taken to treat acne.

Cortisone injections in the abscesses may promote healing.

In severe cases, surgical removal of scarred (fibrotic) skin and underlying diseased tissues may be the only alternative. These areas are often left to heal without skin grafting. It takes about 2 months for these areas to heal, and noticeable scars may result. Another surgical procedure for hidradenitis suppurativa is subcutaneous fistulectomy. In this treatment, the doctor cuts away the bridging fibers between scars. This seems to be an effective approach with less drastic side effects than more invasive surgery.

Prevention

Keeping the affected areas clean with an antibacterial cleanser is helpful. Long-term antibiotics are sometimes necessary to control the disease.

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