Hydradenitis: an unpleasant disease with unpleasant consequences

Hydradenitis is a common purulent disease of the apocrine glands with involvement of the surrounding subcutaneous adipose tissue.

Often, the inflammatory process affects the armpits or inguinal folds, which brings severe pain and discomfort to the patient.

In addition to the inability to lead a normal life during the progression of hidradenitis, the disease can have serious consequences for the patient's health.

On estet-portal.com read about the causes, clinical picture depending on the stage of the disease, as well as complications and features of the treatment of hidradenitis.

Development factors and localization of inflammatory foci on the body

Hydradenitis – purulent inflammation of the apocrine sweat glands caused by staphylococcal infection. Favorable factors in the development of hydradenitis are hyperhidrosis, depletion of the body due to malnutrition, infectious and neuroendocrine diseases.

External factors also play an important role, such as increased skin contamination, microtrauma, cuts as a result of shaving the hair.

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Hydradenitis develops in the localization of apocrine sweat glands – in the axillary cavities, scalp, on the labia majora, nipples, scrotum, inguinal folds or around the anus.

Women of reproductive age are most often affected. In children, the disease is observed only from the pubertal period, when the apocrine glands reach full development and begin to function actively.
Often, the disease acquires a chronic relapsing character.

Stages of development of hidradenitis: the main clinical symptoms of the disease

Hydradenitis usually develops gradually as the abscess forms. The disease is also characterized by a bilateral lesion.

There are 3 phases of the course of hydradenitis:

I.    small tissue infiltration with involvement of one sweat gland

II.    involvement of several sweat glands with the formation of a dense infiltrate;

III.    formation of an abscess, in advanced cases, phlegmon develops.

At first, a feeling of discomfort and slight pain appear in the affected areas. The skin is not changed, only palpation can reveal small dense formations. Further, the skin becomes redder, and painful nodes begin to protrude and increase in size.

After one or two days, the nodes become soft and perforate with pus flowing out (on their own or promptly).

Gradually, the abscess cavity is filled with granulations and the process is resolved by a scar. The maturation of abscesses is often accompanied by fever, severe pain, and general weakness. The cycle of development of a single hidradenitis takes 10-15 days.

In case of recurrent course of hidradenitis (after 2-4 weeks), hyperemia, swelling and severe pain reappear around the formed scar.

The infiltrate becomes more extensive, denser and deeper. The blood picture also changes: leukocytosis and an increased SHOE are characteristic. Often, the purulent process acquires a phlegmonous character of development.

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Differential diagnosis and complications of sweat gland pathology

Hydradenitis can have serious complications with inadequate treatment or in severely weakened individuals.
In case of recurrent course of hydradenitis (after 2-4 weeks), hyperemia, swelling and severe pain reappear around the formed scar. The infiltrate becomes more extensive, dense and deep. Often, the purulent process acquires a phlegmonous character of development.

As a result of this, subpectoral phlegmon, lymphadenitis may develop, and in severe or advanced cases – sepsis.

Hydradenitis must be differentiated from diseases such as lymphadenitis, furunculosis, axillary lymph node tuberculosis, lymphogranulomatosis, felinosis.
    
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Hydradenitis: treatment of acute and chronic inflammation

Depending on the phase of abscess formation, conservative or surgical treatment of hidradenitis is used. At the stage of initial infiltration, the affected areas are treated with antiseptics (2% salicylic, boric alcohol), and with an extensive inflammatory process and severe pain, the focus is chipped with a mixture of novocaine (1%) and an antibiotic.

At the stage of abscess formation, ointment dressings, thermal and physiotherapy procedures are contraindicated.

The use of antibacterial ointments with levomycetin, erythromycin or gentamicin is also indicated.
For multiple, large infiltrates and acute course, systemic antibiotics (macrolides, tetracyclines or cephalosporins) are used parenterally for 7-10 days.

After maturation, it is recommended to open the abscess with further drainage of the cavity and applying a bandage with proteolytic enzymes.

In the healing stage, physiotherapy and non-specific immunotherapy are indicated. Chronic recurrent hidradenitis includes complex therapy: specific immunotherapy (staphylococcal immunoglobulin, toxoid), surgical opening, and if necessary – resection of the sweat glands of the affected area with the replacement of the skin defect with local tissues or skin grafting. 

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