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Hidradenitis suppurativa is a chronic, scarring inflammation of apocrine glands of the axillae, groin, and around the nipples and anus.
Blockage of apocrine ducts has been suggested as the cause, leading to subsequent inflammation, bacterial overgrowth, and scarring. Staphylococcus aureus is almost always implicated in acute cases, but gram-negative organisms such as Proteus may predominate in chronic cases.
Swollen, tender masses resembling cutaneous abscesses develop. Pain, fluctuance, discharge, and sinus tract formation are characteristic in chronic cases. In chronic axillary cases, coalescence of inflamed nodules causes palpable cordlike fibrotic bands. The condition may become disabling because of pain and foul odor.
Diagnosis
Diagnosis is by examination. Bacterial cultures may be helpful if there appears to be a concomitant cellulitis or loculated abscess.
Treatment
Treatment of acute cases consists of high-dose oral tetracycline (500 mg bid), doxycycline (100 to 200 mg once/day), minocycline (100 mg once/day), or erythromycin (250 to 500 mg qid) until the lesions resolve. Topical clindamycin applied bid may be equally effective. Incision and drainage are necessary for an abscess or fluctuance of the affected area but alone do not resolve the problem (unlike in cutaneous abscesses). Isotretinoin 1 mg/kg po bid has also been effective in some patients, but recurrences are common. Intralesional corticosteroid injections (eg, triamcinolone 1 to 10% suspension intradermally) may help with inflammation and pain. Surgical excision and repair or grafting of the affected areas is often necessary if the disease persists. Ablative laser therapy (CO2 or erbium:YAG) is an alternate surgical treatment. Several studies report success in treating hidradenitis suppurativa with etanercept or infliximab, injectable tumor necrosis factor-α inhibitors. Although not the gold standard, this option may be useful when all other treatment modalities have failed.
Last full review/revision October 2007 by A. Damian Dhar, MD, JD
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