HIDRADENITIS SUPPURATIVA

General Information

DEFINITION--A skin disorder characterized by nodules in the armpit.

BODY PARTS INVOLVED--Armpits. It appears rarely on buttocks, groin or under breasts.

SEX OR AGE MOST AFFECTED--Both sexes, but more common in females (13 to 16 years).

SIGNS & SYMPTOMS--

Nodules with the following characteristics:

• Nodules are firm, tender and domed.
• Nodules are 1cm to 3cm in diameter.
• Larger nodules soften in the center and become painful. When pressed, they feel like an overfilled inner tube.
• Nodules open and drain pus spontaneously.
• Individual nodules (with or without drainage) heal slowly over 10 to 30 days.
• Nodules leave scars.
• Severity of the disorder varies from a few lesions per year to a constant succession of lesions that form as old ones heal. Lesions frequently recur at the same site.

CAUSES--Hormonal influences that activate the apocrine glands under the arms. Secretions in these glands enlarge the gland. The outlets become blocked, probably by heat, sweat or incomplete gland development. The secretions that are dammed in the glands force sweat and bacteria into surrounding tissue, which becomes infected.

RISK INCREASES WITH

• Obesity.
• Exposure to environmental heat and moisture.
• Genetic factors. This disorder is most common in black females.

HOW TO PREVENT--No specific preventive measures.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Laboratory culture of the discharge from the draining abscess.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.
• Surgery to open and drain abscesses or to remove involved skin (severe cases only).

POSSIBLE COMPLICATIONS--Scarring.

PROBABLE OUTCOME--This disorder may last many years--from puberty through the following 10 to 20 years. Symptoms can be controlled with treatment.

How To Treat

GENERAL MEASURES--

• Don't use commercial underarm deodorants.
• Minimize heat and sweating.
• Avoid constrictive clothing and clothing made of synthetic fibers.
• Lose weight, if you are overweight.
• Wash with antibacterial soaps.
• Use soaks (see Soaks in Appendix) to relieve itching and hasten healing. Warm-water soaks are usually more soothing for pain or inflammation. Cool-water soaks feel better for itching.

MEDICATION--

• Your doctor may prescribe: Injection of cortisone drugs directly into the lesions. Antibiotics to fight infection. Hormones to help subdue inflammation. Isotretinoin (has been effective in some patients). This is a potent drug and must be given under doctor's supervision.
• For minor discomfort, you may use non-prescription drugs such as acetaminophen.

ACTIVITY--Restrict your activity in hot weather and avoid hot jobs if possible. Swimming is excellent.

DIET--No special diet unless you need to lose weight. Obesity is a main risk factor for this disorder. See Weight-Loss Diet in Appendix.

Call Your Doctor If

• You have symptoms of hidradenitis suppurativa.
• Lesions don't improve after 5 days of treatment.
• Your temperature rises to 101F (38.3C).
• Lesions appear that become soft and seem to have pus, but don't drain spontaneously.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.