Hidradenitis suppurativa Dermnet

 

Hidradenitis suppurativa is an inflammatory skin disease that is characterized by recurrent bump-like abscesses that form pus-like discharge in their last stage of development, leaving difficult healing wounds and scars. The disease often occurs on parts of the body with apocrine sweat glands, such as in the groin, in the armpits and under the breasts. She is also known as “acne inversa”.

What causes hidradenitis suppurativa of and who gets it?

The exact cause of hidradenitis suppurativa remains unclear. What is clear is that this is a disturbance in the form of follicular occlusion. It begins with follicular blockages that impede the apocrine glands and lead in their environment to inflammation. The cellular tissue tears, it comes to bacterial infections, as well as the formation of fistulas between the abscess under the skin and thus the characteristic symptoms.

The following are some factors that probably also play a role:

Inheritance – often hidradenitis suppurativa of cases are reported, affecting or concerned several members of a family.

exualhormone – The function of the apocrine sweat glands are stimulated by androgens and estrogen suppresses (what role these hormones play exactly, remains the subject of controversy)

Endocrine factors – obesity, hirsutism (strong as male hair in women) and acne are common in women with hidradenitis suppurativa.

Smoking – Hidradenitis suppurativa seems to occur more frequently in smokers than in nonsmokers.

Women are of hidradenitis suppurativa affected three times as frequently as men; the reason is unknown. The disease is most common between the ages of 20-40 and will coincide with the post-pubertal increase in androgen. Before puberty and after menopause, the disease breaks out rarely.

In some people hidradenitis suppurativa is a part of the follicular occlusion syndrome, associated with acne conglobata, chronic Follikelerkrankungen the scalp and / or Pilonidalfisteln.

What are the symptoms of hidradenitis suppurativa and signs?

The extent and severity of the disease varies greatly between the different stakeholders. Most initially a firm, pea-sized nodules appear from 0.5 to 1.5 cm in diameter, which looks similar to acne. These lesions can break spontaneously or within hours to days and secrete pus-like discharge. You can be heal without treatment, however, occur at a later date new abscesses in the neighboring regions. Unchecked, this leads to the development of larger bumps (golf ball size), formation of fistulas and the spread over the area acutely affected also. Three different clinical phases have been defined for the state:

Level 1 – single or multiple isolated abscesses without scarring or sinus tracts.

Stage 2 – recurrent abscesses, individually or more distant from each other, with formation of fistulas.

Level 3 – widely affected areas, with many interconnected sinus tracts and abscesses.

The disease can spread to less common parts of the body such as the neck, the waist and the inner leg portions. The anogenital dissemination usually affects the groin, pubis, vulva, sides of the scrotum (scrotum), perineum, buttocks and Perianalfalten. The abscesses and fistulas can be painful.

How to treat hidradenitis suppurativa?

The medical treatment of hidradenitis suppurativa is difficult. The aim is to diagnose the disease at an early stage, treat and control these milder forms. Weight loss in obese patients, and smoking cessation are recommended.

General measures include:

Washing with antiseptics or acne preparations to reduce the proliferation of symbiotic bacteria. Hydrogen peroxide solution and medical grade honey proved helpful.

Wear loose-fitting clothing to avoid friction.

Begin a low glycemic diet (small increase of blood glucose levels), and strive for the ideal body weight.

Do not smoke.

The medical treatment includes:

  • Thematic anti-acne antibiotics such as clindamycin or erythromycin, applied in the affected areas in combination with benzoyl peroxide.
  • Quick treatment with oral antibiotics for acute abscesses (red, hot painful perception of the bumps) by staph infection. Dicloxacillin Flucloxacillin or are most suitable, except for penicillin allergy.
  • Longer administration of tetracycline or metronidazole (minimum 3 months), anti-inflammatory.
  • Three-month Verabreichnung the combination of clindamycin and rifampicin may be the most effective medical treatment in severe cases.
  • Attempt der Einnahme of contraceptives (contraceptives) for 12 months or more – usually Diane-35 or Estelle 35, containing little estrogen and cyproterone acetate. The antiandrogenic diuretic spironolactone may also be of use.
  • Retinoids (vitamin A derivatives) for 6 to 12 months, in particular isotretinoin, the ideal place for acne can also help with hidradenitis suppurativa.
  • (Directly in the node injections) reduce Systemic corticosteroids or intralesional corticosteroids severe inflammatory abscesses.

In severe cases, the use of biological response mediators such as infliximab, etanercept and another TNF antagonist, is worth considering.

Surgical treatment includes:

  • Incision and drainage of abscesses – in particularly painful stage.
  • Persistent hidradenitis herd may be removed (ie maintenance and / or antibiotics) after several months of conservative treatment.
  • Surgical removal is very severe cases of hidradenitis suppurativa reserved.
  • Experimentally may be useful in some cases, laser ablation.
  • Carbon dioxide laser treatment is a relatively new treatment for hidradenitis suppurativa. It is suitable for mild to moderate ill and does not require hospitalization.

By Nina Restau of www.akne-inversa.info.

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