DEAR DR. GOTT:
I have a form of acne that is called hidradenitis suppurativa. Could you please tell me if there is anything that will clear this up?
DEAR READER:
Hidradenitis suppurativa is considered to be a severe form of acne that causes chronic skin inflammation. It is marked by the presence of blackheads and one or more tender lesions which often enlarge, break open and drain pus.
It commonly occurs around hair follicles and oil and sweat glands. It is frequently found in the armpits, anal area and groin. It can occur in any area where skin rubs together such as the inner thighs. It can affect one or several areas of the body.
Women are more likely to develop hidradenitis suppurativa. A family history of the condition increases the risk of developing it. It generally affects those between puberty and age 40; however, it can occur in those over 40 and, rarely, children.
Symptoms include small pitted areas that contain blackheads (often in pairs), pea-sized lumps under the skin that are painful, one or more red, tender, pus-filled lesions that can burst and drain unpleasant smelling fluid accompanied by itching, burning or excessive sweating and painful sores that continually leak fluid that heal very slowly or not at all, leading to scarring.
Symptoms generally start at puberty. They often begin with a single painful lesion that persists for weeks or months. For some, symptoms are mild. Others may experience progressive worsening and spreading. Excessive weight, stress, hormonal changes, heat or perspiration may exacerbate symptoms.
Scarring, under skin tunnels, cellulitis (skin infections) and restricted movement are common consequences. It is, therefore, important to report all symptoms to a physician, or better still, a dermatologist.
Treatment depends on the severity, location, number of locations, recurrence and more. Mild cases can often be treated with self-care. More severe cases may require prescription medications or surgery. Medication can include antibiotics, oral retinoids (to stop oil gland functions and preventing plugging of hair follicles), corticosteroids/immunosuppressants (prednisone and others), and non-steroidal anti-inflammatories (Advil, etc.).
Persistent or severe cases and those with deep lesions may require surgery to drain or remove them. Those patients who develop tunnels or tracts under the skin may need to have them surgically opened to promote healing. A final option is complete removal of the lesion and surrounding skin following by closure with skin grafting or skin flaps. These steps do not prevent future outbreaks, however.
Home care can include warm compresses to reduce swelling, washing affected areas with antibacterial soap followed by applying over-the-counter antibiotic creams. Loose-fitting clothing and undergarments can reduce skin irritation as well as can avoiding shaving the areas. Reducing weight can limit the number of areas where skin rubs against skin, thus leading to less irritation. Daily zinc gluconate supplements may reduce inflammation and prevent new outbreaks.
If you are not already doing so, I recommend you see a dermatologist who can help you decide on treatment options and keep you up-to-date on the latest breakthroughs.
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