The appearance of such a defect as hidradenitis leads many to a stupor. After all, this is a severe inflammation of the sweat glands, which is a lump. Often painful. The appearance of such a defect should not be ignored, because due to the purulent contents it is fraught with negative consequences.
Alexander Gushchin, PhD, surgeon, clinical anatomist of the Russian National Research Medical University named after AiF.ru, told AiF.ru about why such a problem appears in principle, what needs to be taken into account in connection with it and how to deal with education N.I. Pirogov Ministry of Health of Russia .
Clinical picture
When there is a feeling of itching, slight pain and a feeling of tension in the axillary fossae (the most common localization), less often in the perineal region or in the circumference of the navel and nipples in women (i.e. in the areas of localization of the apocrine glands), a dense painful node appears, dia. 0.5-1 cm. The node is located in the upper part of the subcutaneous fatty tissue, directly under the dermis. Then the pain intensifies, the node increases to barely 3 in diameter, sharply protrudes in the form of a hemispherical formation. The skin over it becomes purplish-red in color and becomes fused with the infiltrate. Soon the node softens, a fluctuating abscess is formed, which opens with the release of a small amount of creamy pus. The development cycle of one inflammatory infiltrate lasts 10-15 days. Healing of hidradenitis occurs with the formation of a scar.
Hidradenitis.
Often another sweat gland, sometimes several sweat glands, is involved in the process; an extensive, dense, very painful infiltrate with an uneven, bumpy surface may develop (Fig. 4).
G.'s course can be conditionally divided into three phases: the first phase is a slight infiltration of tissues with the involvement of one sweat gland in the process, the skin over the cut may not be changed; second phase - several sweat glands are involved with purulent infiltration of the tissue around them and the formation of a dense infiltrate of purplish-red color; the third phase is the formation of an abscess (see), in advanced severe cases - phlegmon (see).
The onset of G. is usually acute: high body temperature, headache, leukocytosis, accelerated ROE. In cases of sequential involvement of the sweat glands in the process, the disease takes a chronic course.
Possible complications
: lymphangitis and lymphadenitis, phlegmon, sepsis.
Diagnosis of hidradenitis
Diagnosis of hidradenitis is carried out according to the clinical picture characteristic of this disease. It is not difficult to establish the disease; this is also helped by the special localization of the process. The doctor examines the patient and conducts a survey, finding out how long ago the lumps appeared, whether they were accompanied by pain and itching, how quickly the lump grew, and whether the patient has ever had cases of hidradenitis. Then a blood test and bacteriological examination are prescribed. With hidradenitis, a blood test reveals signs of inflammation, and a bacteriological examination helps determine how the microorganism led to the occurrence of hidradenitis. In addition, culture of the discharge is carried out so that the doctor can prescribe adequate antibiotic therapy.
If hidradenitis occurs in a protracted form, then it is necessary to examine the immune system by taking an immunogram. When conducting diagnostics, it is necessary to differentiate hidradenitis from boils, lymphadenitis and tuberculosis.
Treatment
When G. is localized in the axillary fossa, immobilize the limb (on a scarf or Deso bandage). Antibiotic therapy for 5-7 days; the choice of antibiotic is based on the sensitivity of the microbial flora. Prescribe penicillin (intramuscular) 100,000 units after 4 hours or in the form of durable drugs up to a total dose of 2,500,000-3,000,000 units per course for the acute form of G. and up to 5,000,000-7,000,000 units for chronic, recurrent form ; semisynthetic Penicillins (Methicillin, oxacillin, ampicillin) parenterally, 0.25-0.5 g 4 times a day until complete resolution of the disease. Tetracyclines (chlortetracycline, etc.) are also used orally, 0.2-0.25 g 4-5 once a day, per course 6.0-15.0 g; Rondomycin is recommended orally 150 mg 2 times a day, for a course of 2.5-3.0 g; erythromycin, oleandomycin - orally 200,000-250,000 units 4-5 times a day, per course 5,000,000-10,000,000 units; sulfonamides according to generally accepted dosages. Autohemotherapy and pyrotherapy are prescribed.
Antibiotic treatment is combined with ultraviolet irradiation, UHF, and ultrasound therapy, which is carried out daily for 7-15 days until the infiltrate is completely resolved.
The skin in the affected area is treated with disinfectant solutions (boric-camphor alcohol, aniline dyes). Pure ichthyol or mercury patch is applied to the infiltrate; syntomycin emulsion (5-10%), ointment with neomycin (3-5%), erythromycin, etc. are also recommended. Warming compresses are contraindicated, because they cause maceration of the skin and can contribute to the spread of infection.
In case of a recurrent form, specific immunotherapy is carried out (staphylococcal vaccine, staphylofiltrate, toxoid A2, staphylococcal antiphagin, etc.), gamma globulin, and restorative treatment.
When the infiltrate softens with the formation of an abscess (fluctuation), a puncture is performed with suction of pus and subsequent injection of an antibiotic into the abscess cavity, or a small incision is made in the center of the abscess under local anesthesia or intravenous anesthesia. Then, for the active outflow of pus, bandages with hypertonic sodium chloride solution are applied until the wound is completely cleansed; when granulations appear - bandages with synthomycin or chloramphenicol emulsion (5-10%), etc.
With the formation of an extensive tuberous infiltrate, the development of phlegmon, especially with threatening sepsis, the Voino-Yasenetsky operation is indicated, which consists of a wide excision of the inflamed subcutaneous tissue within healthy tissue (under local anesthesia or endotracheal anesthesia). In extremely severe cases, they resort to complete excision of the scalp and all subcutaneous tissue of the axillary region, followed by relocation of skin flaps or the use of free skin grafting with a full-thickness flap taken from the surface of the thigh or buttock.
In the acute and chronic course of G., especially with multiple foci, X-ray therapy is indicated simultaneously with general treatment (antibiotics, etc.), edges in the initial stage of infiltration leads to rapid relief of the process, and at a later date - to the acceleration of abscess formation. Irradiation is carried out at a voltage of 120 kV, a filter of 3 mm aluminum, the source-skin distance is 30 cm. In the initial stage of G., a single dose of 15-20 rads, irradiation is done daily up to a total dose of 45-75 rads. The effect occurs in the first 1-3 days. When irradiated in the later stages of G., the single dose increases to 30-40 rad, and the total dose - to 120-160 rad. Irradiate at intervals of 2-3 days.
When a clear fluctuation appears, an incision is made without waiting for spontaneous opening.
Protection from the problem
How to protect yourself from hidradenitis? It is impossible to completely protect against the likelihood of developing the disease under unfavorable conditions. But you can significantly reduce the risk of its occurrence by careful hygiene (but not excessive!), wearing loose and ventilated clothing, using hygiene and cosmetic products that are suitable for your skin (with repeated use there is no irritation, itching, or redness).
People who have had this problem before, and sometimes more than once, should especially carefully monitor the condition of the skin and microclimate of the axillary area. You should also pay attention to the factor of heredity - if your relatives have had repeated occurrence of this pathology, then most likely you have inherited a certain hyperfunctional background of the apocrine sweat glands.
Deodorant, injections, surgery... How to get rid of excessive sweating? More details
And remember, attention to the problem and passion for the problem are two different situations leading to different results: prevention or, conversely, provoking the development of pathology. Hidradenitis is just the most striking example among numerous human diseases.
Prevention
Compliance with the rules of personal hygiene, daily washing and wiping the skin with boric or salicylic alcohol, deodorants; treatment of hyperhidrosis, diaper rash, endocrine disorders and other pathological conditions that contribute to the occurrence of hidradenitis. Frequent shaving of hair in the armpit is not recommended.
Bibliography
Arutyunov V. Ya. Skin and venereal diseases, M., 1972; Belenky G. B. Pustular diseases of the skin, M., 1963; Multi-volume guide to dermatovenerology, under. ed. S. T. Pavlova, vol. 2, p. 191, 221, L., 1961; Multi-volume guide to surgery, ed. B.V. Petrovsky, vol. 2, p. 248, M., 1964; Struchkov V.I. et al. Antibiotics in surgery, M., 1973; Petres J.u. Vibrans U. Zur operati ven Therapie der axillaren Hydradenitis suppurativa, Hautarzt, Bd 23, S. 160, 1972;Pollock WJ, Virnelli FR a. Ruan RF Axillary hidradenitis suppurativa, Plast. reconstruct Surg., v. 49, p. 22, 1972.
Arkhangelsky, M. V. Galeev, Yu. G. Elashov.
Causes of hidradenitis
The causative agent of hidradenitis is Staphylococcus aureus, which penetrates the apocrine glands through their excretory ducts. Hidradenitis can have different causes. The main ones are failure to comply with personal hygiene rules, microtraumas, cuts and scratches in the armpit area that occur when shaving or wearing tight clothes.
Predisposing factors for the development of hidradenitis are general weakening of the body, constant moisture of the skin due to increased sweating, as well as an alkaline reaction of sweat. Provoking factors for the occurrence of hidradenitis can be obesity, diabetes mellitus, and a hereditary predisposition to the occurrence of acne.
Apocrine sweat glands develop only during puberty, and in girls this development occurs earlier. For this reason, hidradenitis occurs more often in women than in men. With old age, the function of the apocrine sweat glands declines, so hidradenitis is not observed in older people.
Medicines
Photo: medbook.propto.ru
The choice of means and methods of treating hidradenitis largely depends on the stage of the disease and the nature of its course. Thus, in the early stages of the disease, dermatologists often prescribe medication treatment to their patients.
Surgery is performed only if treatment of hidradenitis with ointments and tablets for a long time has not brought any results.
As a rule, the conservative approach is to treat hidradenitis with antibiotics. They can be used both internally and externally in the form of various ointments, creams, sprays, etc. However, no matter what form the medicine is in, only a doctor can prescribe it. This is due to the fact that antibiotics for hidradenitis can cause addiction in the body, which in the future can negatively affect the effectiveness of therapy.
Good results in treating the disease are also shown by ointments that have the ability to draw purulent contents out.
However, any medications must be prescribed by a specialist in the appropriate field. Only he knows which antibiotics for hidradenitis and ointments should be prescribed to a particular patient.
Vishnevsky ointment
Doctors have ambivalent views on the use of Vishnevsky ointment, because sometimes it speeds up the process of pus production.
This product contains tar, camphor and castor oil. These components of the medicine have a mild irritating and warming effect.
After applying the product to the affected area, it warms up and the blood supply in it improves. All this leads to the rapid development of the inflammatory process.
This means that Vishnevsky ointment for hidradenitis is prescribed only if the pathology has already entered the suppuration phase. In this situation, the essence of its use is to speed up the process of opening the abscess. That is, ointment for hidradenitis is used not to suppress, but to intensify the inflammatory process.
However, it is still not advisable to use this medicine in the initial stages of the disease. This is why it is so important that Vishnevsky ointment for hidradenitis is prescribed by a specialist.
A contraindication to the use of the medicine is an allergy to the components of the medicine.
Ichthyol ointment
Ichthyol ointment is another effective remedy for hidradenitis. It, like Vishnevsky’s ointment, speeds up the opening process.
In this case, doctors recommend making medicinal ointment compresses at night. Sometimes medicine can replace surgical opening of the cavity.
The remedy has shown the greatest effectiveness in the treatment of sluggish hidradenitis, in which the inflammatory process is weak, but long-lasting. As a rule, ichthyol ointment for hidradenitis is prescribed in combination with antibacterial drugs for oral administration.
Contraindications to the use of this medicine include hypersensitivity to the components of the medicine, pregnancy and lactation, and age under 12 years.
Levomekol
Levomekol is an ointment that has antibacterial, regenerating and anti-inflammatory effects. It contains chloramphenicol (an antibiotic) and methyluracil. It is worth noting that in severe cases of the disease, the doctor may prescribe levomethicin in tablet form orally.
Since levomekol is a product created on the basis of several drugs, it can therefore replace several drugs.
Levomycetin contained in the medicine has a detrimental effect on staphylococci, streptococci, E. coli and many other bacteria. At the same time, methyluracil accelerates the process of tissue regeneration. In addition, it effectively simulates local immunity, thanks to which the body eliminates the infection faster.
For the same reason, Levomekol is able to fight not only bacterial but also viral infections.
Levomekol for hidradenitis is a relatively safe ointment. The only contraindication to its use is the presence of an allergic reaction to the components of the product.
However, only a doctor should prescribe the ointment, since in some cases it can cause side effects, including swelling, rash, itching and redness of the skin.
If these symptoms occur, the patient should consult a doctor as soon as possible. When changing the drug, the side effects disappear within a few days.
Erythromycin
Erythromycin for hidradenitis can be prescribed in different forms, both in tablets and as an ointment. The choice of the form of the drug and the scheme of its use in this case is made by the doctor, based on the degree of the disease and the nature of its course.
This antibiotic can affect both gram-positive and gram-negative bacteria. Unlike antibiotics of the penicillin group, erythromycin ointment for hidradenitis is much more easily tolerated by patients.
Erythromycin stops protein synthesis by pathogenic microorganisms, which leads to their death and a decrease in the inflammatory process.
Unfortunately, erythromycin (in any form), like most medications, has its contraindications. Thus, this remedy is not recommended to be used if the patient has intolerance to the components of the drug or severe liver disease. Pregnant women and children should consult a doctor before using the drug.
Among the side effects of the drug, patients sometimes report dizziness, swelling, migraines and difficulty breathing.
Dimexide
Dimexide is a drug for external use that has anti-inflammatory, antibacterial and mild analgesic effects.
Dimexide has a low price and can be purchased at any pharmacy.
Its main function is to conduct other drugs into the deeper layers of tissue, that is, it acts as a conductor.
However, this product can only be used as prescribed by a doctor, since if used incorrectly, it can cause a chemical burn or introduce toxic substances into the body along with beneficial substances.
Pregnant women and patients with liver and kidney diseases should avoid using dimexide for hidradenitis.
Among the side effects of the drug, patients often note nausea, allergic reactions, breathing problems and burning.
As a rule, the doctor selects individually for the patient the medications that need to be used with dimexide to achieve the best results. To do this, the patient must independently make various mash-ups and ointments containing dimexide. It is important not to self-medicate. Only a doctor knows exactly what to apply for hidradenitis to his patient.
Amoxicillin
Amoxicillin is an oral antibiotic. It effectively fights pathogenic bacteria - the causative agents of hidradenitis.
Its absorption in the stomach occurs within 15-30 minutes after administration. It reaches its greatest activity after 2 hours, and its duration of action is 8 hours.
Amoxicillin for hidradenitis is not recommended for use by pregnant and breastfeeding women, patients suffering from kidney and liver diseases and allergy sufferers.
Side effects of amoxicillin include allergies, disorders of the digestive system, and damage to the central nervous system.
Amoxicillin is strictly not recommended to be combined with alcohol and certain types of medications, which is why it is so important that the drugs for the treatment of hidradenitis and their dosage are prescribed by a doctor.
Disorders with similar symptoms
Symptoms of the following disorders may be similar to those of hidradenitis suppurativa. Comparisons can be useful for differential diagnosis:
- Furunculosis is characterized by the development of inflammatory nodules, known as boils or carbuncles, due to infection by the staphylococcus bacteria. Boils are red, tender or painful lumps that secrete a central core of tissue and pus. They can sometimes be repeated. Contributing factors that make a person vulnerable to furunculosis may include obesity, diabetes and poor hygiene.
- Skin tuberculosis is an infectious disease caused by the bacteria Mycobacterium tuberculosis (Koch bacillus).
- Crohn's disease is an inflammatory bowel disease that can rarely have skin manifestations that mimic those of hidradenitis suppurativa.
There are a number of other diseases that may present with symptoms similar to those associated with Velpeau's disease.
Forecast
Hidradenitis suppurativa is a chronic disease, i.e. it doesn't go away on its own. Despite ongoing treatment, the boils usually continue to return. The disease usually progresses gradually, with abscesses appearing more frequently, in greater numbers, and affecting more areas of the body. The condition is not life-threatening, but people with the disorder may experience frequent pain, difficulty moving, and feel embarrassed or ashamed about their illness. It can cause social isolation, depression and/or anxiety and affect a person's quality of life.
Notes
- Hidradenitis Medical Encyclopedia
- Pyoderma. Russian Medical Journal
- [1], General surgery practical classes Kharkov 2010 Textbook.
- Hidradenitis
- Hidradenitis
- Pseudofurunculosis. Hidradenitis. Clinic, course, diagnosis, treatment, prevention. VTE. Dermatology, skin, skin diseases, structure of the skin, skin morphology Archived copy of April 12, 2010 on the Wayback Machine
- Sweaty hands - hidradenitis, purulent inflammation of the sweat glands
- HYDRADENITIS: treatment, description, symptoms, complications, prevention
