About hidradenitis axillaris

What is hidradenitis axillaris?

Hidradenitis suppurativa (HS) is a chronic condition characterized by swollen, painful lesions, occurring in the armpit (axillae), groin, anal, and breast regions. This disease occurs due to obstruction of hair follicles and secondary infection and sometimes inflammation of certain sweat glands (apocrine glands). It is a progressive disease where single boil-like, pus-filled abscesses become hard lumps, then painful, deep-seated, often inflamed clusters of lesions with chronic seepage. Healing of affected areas is typically associated with progressive scarring (fibrosis). The formation of chronic epithelialized, sometimes interconnected, sinus tracts occurs in severe disease. This often leads to the entrapment of perspiration and bacteria in the surrounding tissue, which causes inflammation and infection. HS can be extremely painful and debilitating but is rarely life-threatening; only occurring when the bacteria infection leads to an overwhelming systemic infection in an individual with a weakened immune system.

HS was once thought to be a rare disorder because only the most severe cases were reported. HS was first described in the medical literature by Velpeau in 1839 and was considered an extremely severe form of acne (acne inversa). It most often presents at puberty because of changes in hair follicles triggered by the surge in sex hormones. The condition may also begin to occur in patients of any age after puberty, but rarely before. Cases vary in severity, but all require some treatment and management. For mild cases, home remedies may be all that is needed. For severe forms, however, daily medication is often prescribed and radical surgery may eventually be recommended. Early diagnosis and treatment of HS are important because they can help manage symptoms and prevent new boils and lesions from forming.

What are the symptoms for hidradenitis axillaris?

Pain symptom was found in the hidradenitis axillaris condition

Some people with this condition experience only mild symptoms. The course of the disease is highly variable. Excess weight and being a smoker are associated with worse symptoms, but even people who are thin and don't smoke can experience severe disease.

What are the causes for hidradenitis axillaris?

Hidradenitis suppurativa develops when hair follicles become blocked. The exact cause for this isn't known. Experts think it could be connected to hormones, genetic predisposition, cigarette smoking or excess weight.

Hidradenitis suppurativa is not caused by an infection or being unclean, and it can't be spread to other people.

What are the treatments for hidradenitis axillaris?

Treatment with medications, surgery or both can help control symptoms and prevent complications of hidradenitis suppurativa. Talk with your doctor about the risks and benefits of the treatment options and how to develop an approach tailored to you.

Expect to have regular follow-up visits with your dermatologist. Some people might need the comprehensive care provided by a multidisciplinary health care team.

Medications

Your doctor might prescribe one or more of the following types of medications:

  • Antibiotics applied to the skin. Mild symptoms might be managed with a topical antibiotic in liquid or gel form. For more-widespread disease, your doctor might prescribe antibiotic pills, such as doxycycline (Monodox), clindamycin (Cleocin), rifampin (Rimactane) or both. People with severe disease might need to take antibiotics for months.
  • Steroid injections. Triamcinolone (Aristospan, Kenalog-10) injected into the sores might help reduce swelling and inflammation.
  • Hormonal therapy. Hormone pills, such as estrogen-containing combined oral contraceptives (Estrace, Prefest), might be effective for people with mild hidradenitis suppurativa.
  • Biologics. These drugs, usually administered by injection, alter the immune system in a way that disrupts the disease cycle and improves symptoms and signs of disease within weeks. Several of these drugs are approved for the treatment of moderate to severe hidradenitis suppurativa. Two of them are the tumor necrosis factor (TNF) inhibitors adalimumab (Humira) and infliximab (Remicade). Many other biologics are in clinical trials for hidradenitis suppurativa.
  • Retinoids. Oral retinoids might be an option for some people with acnelike (acneiform) disease. These drugs are not recommended when you're pregnant or breastfeeding or if you intend to become pregnant.
  • Pain medication. If over-the-counter pain relievers don't help, your doctor might prescribe a stronger pain medication or refer you to a pain clinic.

Surgery

Combined medical and surgical approaches help manage hidradenitis suppurativa. Surgery is an important part of disease management when a tunnel and bump (abscess) are present. Which surgical approach is right for you depends on the extent and severity of your condition. Talk with your doctor about the risks and benefits of the options, which include:

  • Uncovering the tunnels. This procedure involves removing tissue (unroofing) to expose the tunnels under the skin. It's used for people with moderate or severe hidradenitis suppurativa. This solution usually doesn't have to be repeated.
  • Punch debridement. This procedure, also called limited unroofing, involves removing a single inflamed bump.
  • Laser therapy. A carbon dioxide laser can be used to make hidradenitis suppurativa sores go away. After this type of treatment, the sores are not likely to return. Laser hair removal can help hidradenitis suppurativa in early stages.
  • Surgical removal. This approach might be an option for people with persistent or severe symptoms. It involves removing all of the affected skin. A skin graft might be needed to close the wound. Even after surgery, sores might still occur in other areas.
  • Incision and drainage. Surgical drainage is no longer considered an effective option for treating hidradenitis suppurativa. The method might be considered to provide short-term pain relief, but afterward, sores usually flare again.

What are the risk factors for hidradenitis axillaris?

Factors that increase your chance of developing hidradenitis suppurativa include:

  • Age. The risk of hidradenitis suppurativa is higher for people in their 20s and 30s.
  • Sex. Females are more likely to develop hidradenitis suppurativa than are males.
  • Race. Ethnicity or race might affect risk level. In the United States, the condition's prevalence is disproportionately high among Black people.
  • Family history. A tendency to develop hidradenitis suppurativa can be inherited.
  • Certain conditions. Hidradenitis suppurativa is more common and severe in people who are overweight. It also has an association with severe acne, arthritis, diabetes, metabolic syndrome and inflammatory bowel disease.
  • Smoking. Smoking tobacco has been linked to hidradenitis suppurativa.

Is there a cure/medications for hidradenitis axillaris?

Hidradenitis axillaris is an inflammatory skin disease that causes painful, pus-filled cysts to form in the sweat glands around the groin, armpits, and breasts, primarily around the hair follicles. It happens when hair follicles become obstructed. This particular skin condition is common from puberty until mid-life. And it disproportionately affects women. The severity and specific symptoms of Hidradenitis axillaris differ between individuals.

There are several effective treatments for hidradenitis axillaris that allow you to manage your symptoms with or without the use of medication or surgery. The following are some of the most effective HA treatments.

  • HA symptoms can range from mild to severe, and conventional treatments rarely work. It is important to note that hidradenitis suppurativa is not caused by an infection or being unsanitary, and it is not contagious.
  • Depending on the severity of the symptoms, dermatologists may recommend oral antibiotics or liquid gels.
  • Anti-inflammatory drugs may also be prescribed to reduce swelling and pain.
  • This skin condition can also be caused by environmental and behavioral factors.
  • Obesity and smoking are common among people with hidradenitis axillaris.
  • Avoiding tight clothing, harsh products, and rubbing the affected area's skin can lead to infection.
  • If all other treatments are ineffective, surgery is the last resort.


Symptoms
Intense pain and discomfort in the affected region,Redness,Pus-filled cyst,Ulcers,Frictional pain
Conditions
The affected areas are prone to infection, which can lead to skin cancer,Scarring may also develop
Drugs
Antibiotics (doxycycline, clindamycin, rifampin),Hormone therapy,Immune modulator (Biologics)

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