Acute and chronic hidradenitis
Acute hidradenitis develops when bacteria, most often Staphylococcus aureus, enters the ducts of the sweat glands through microtrauma. The process is usually single and does not return after treatment. Chronic hidradenitis suppurativa is structured differently: it begins with a blockage of the hair follicle and inflammation, in which the immune system plays a major role, and bacteria are added secondarily. This form often appears after puberty, lasts for years with exacerbations and leads to the formation of passages under the skin and scars.
- Acute hidradenitis suppurativa - single abscess
- Chronic hidradenitis suppurativa (acne inversions)
- Easy stage - individual nodes without fistulas
- Moderate - recurring abscesses with fistulas
- Severe - merging lesions and scars
Causes and risk factors
Sweating, friction from clothing, cuts from shaving, deodorants that irritate the skin, and reduced immunity predispose to acute inflammation. The chronic form is associated with hereditary predisposition, hormonal influences, smoking and obesity. Excess weight increases friction and moisture in the folds, and smoking increases follicle blockage. The disease is not associated with uncleanliness and is not transmitted from person to person, although patients are often embarrassed by this and consult a doctor late.
- Smoking
- Excess body weight
- Diabetes mellitus
- Shaving and epilation of armpits
- Tight synthetic clothing
- Heredity
Symptoms
First, a dense, painful nodule under the skin appears in the armpit or groin, which itches and interferes with movement. Over the course of a few days, it enlarges, the skin above it turns red and acquires a bluish tint, and the node fuses with it and resembles an udder. Then softening appears in the center, and the abscess can open with the release of thick pus. In the chronic form, the nodes reappear, passages are formed connecting the lesions, paired black dots and retracted scars.
- Painful tight knot in the fold
- Redness and swelling of the skin
- Softening and discharge of pus
- Limitation of hand movement
- Increased temperature with an abscess
- Chronic fistulas and scars
Diagnostics
The diagnosis is made upon examination based on the characteristic location and type of nodes. The doctor clarifies how many exacerbations there were, whether there are fistulas and scars, whether the patient smokes, or whether there is diabetes. Culture of pus helps to select an antibiotic if the course is persistent. Ultrasound of soft tissues shows the size of the abscess and subcutaneous passages, which is important before surgery. It is necessary to distinguish hidradenitis from a boil, inflamed atheroma, lymphadenitis and Crohn's disease with damage to the perineum.
- Examination by a dermatologist or surgeon
- Culture of discharge for microflora and sensitivity
- Complete blood count and glucose
- Ultrasound of soft tissues
- Assessment of the stage of the chronic process
Treatment and prevention
At the early stage of acute hidradenitis, the doctor prescribes antibiotics and local antiseptics. A mature abscess is opened and drained by a surgeon; You cannot squeeze out or pierce the knot yourself, as well as apply warm compresses without a prescription. The chronic form is treated for a long time: with courses of anti-inflammatory antibiotics, local remedies, and in severe cases - with genetically engineered drugs. Recurrent lesions with fistulas are excised surgically. Quitting smoking and losing weight significantly improves the course.
- Do not squeeze or pierce knots
- Stop smoking
- Lose weight if you are overweight
- Wear loose cotton clothes
- Remove hair carefully or temporarily stop shaving
- Control sugar levels in diabetes
