Hydradenite

Hydradenitis is a deep purulent inflammation of the apocrine sweat glands. Most often, hydradenitis occurs during puberty or in the menopausal period, when there is a hormonal imbalance.

The content of the article:
Causes of hydradenitis
Symptoms of hydradenitis
Diagnosis of hydradenitis
Complications of hydradenitis
Treatment of hydradenitis
Hydradenite
In most cases, the disease is unilateral, but there is also bilateral hydradenitis. Inflammation mainly develops in the armpit, less often around the nipples, in the anus or genitals.

It is in these areas that the apocrine sweat glands are located. They have wide ducts open to the penetration of pathogens. And the secret of the apocrine glands is an excellent nutrient medium for them. In addition, the inguinal region and armpits are often overheated and injured by clothing, which also contributes to the penetration of microorganisms.

Causes of hydradenitis
The causative agent of hydradenitis is Staphylococcus aureus, which invades the apocrine glands through their excretory ducts. Hydradenitis can have different causes. The main ones are non—compliance with the rules of personal hygiene, microtrauma, cuts and combs in the armpits that occur when shaving or wearing tight clothes.

Predisposing factors for the development of hydradenitis are a general weakening of the body, constant skin moisture due to increased sweating, as well as an alkaline sweat reaction. The provoking factors for the occurrence of hydradenitis may be obesity, diabetes mellitus, hereditary predisposition to acne.

Sweat apocrine glands develop only during puberty, and in girls this development occurs earlier. For this reason, hydradenitis is more common in women than in men. By old age, the function of the sweat apocrine glands is fading, therefore, hydradenitis is not observed in elderly people.

Symptoms of hydradenitis
After the causative agent of hydradenitis enters the sweat gland, it begins to grow rapidly, multiply and capture new areas: subcutaneous fat and neighboring glands. Externally, it looks like this: a small single fast-growing node appears in the axillary region. The stage of infiltration begins. The skin above the node swells and turns red. When the patient moves his hand, slight soreness occurs, especially when pressing. The growth of nodes can also be accompanied by itching. In a short period of time, literally a few days, microbes are able to move into new sweat glands. In these areas, the formation of hilly nodes occurs in the thickness of the skin and under it, which grow rapidly, tightly fused with the skin. At this stage of the development of hydradenitis, the nodes resemble pear-shaped protrusions or nipples in appearance. That is why the disease got its second name — “bitch udder”.

Further, the formations can merge into a single whole and soften. The skin above them turns blue and swells strongly, while the pain increases. It bothers the patient even at rest. About two weeks after the onset of the inflammatory process, the so-called swell, or fluctuation, can be determined in the nodes. It serves as a sure sign that liquid pus has formed under the skin. Then there is a spontaneous autopsy and the release of pus, resembling a creamy liquid with an admixture of blood.

Sometimes with hydradenitis, a diffuse dense infiltrate may occur, and the signs of the disease resemble phlegmon (purulent inflammation of fatty tissue with an acute course). At the same time purulent hydradenitis is accompanied by a deterioration in well-being:

weakness;
by increasing the temperature;
headaches.
This clinical picture corresponds to the next stage — the maturation of hydradenitis.

After opening the nodes, the tension and swelling of the skin weaken, the pain gradually decreases and disappears completely. The scarring process begins, lasting for several days. It may take longer for the infiltrate to dissolve. The full cycle of the disease development takes two weeks. However, hydradenitis can affect more and more sweat glands, then the course of the disease stretches for several months. Most often, this is observed with improper or untimely treatment, non-compliance with personal hygiene rules or with concomitant diseases that reduce immunity.

If there is no adequate drainage of the purulent focus, then the process spreads to the surrounding soft tissues and leads to the formation of an abscess. With advanced stages of hydradenitis, the infection can enter the bloodstream, spread throughout the body and lead to sepsis.

When hydradenitis occurs in the genital area or the anus, complications manifest themselves in the form of fistulas of the bladder, urethra or rectum.

Diagnosis of hydradenitis
The diagnosis of hydradenitis 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 seals appeared, whether they were accompanied by pain and itching, how quickly the node grew, and whether the patient has ever had cases of hydradenitis. Then a blood test and a bacteriological examination are prescribed. With hydradenitis, signs of inflammation are detected in the blood test, and a bacteriological study helps to determine how the microorganism led to the appearance of hydradenitis. In addition, the seeding of the discharge is carried out so that the doctor can prescribe adequate antibiotic therapy.

If hydradenitis occurs in a prolonged form, then it is necessary to examine the immune system by making an immunogram. During the diagnosis, it is necessary to differentiate hydradenitis from furuncle, lymphadenitis and tuberculosis.

Complications of hydradenitis
Hydradenitis is a disease that causes a deep lesion of the skin, accompanied by complications, which occurs most often in patients with weakened immunity or due to lack of treatment.

At the stage of disease development and node maturation, the surrounding fatty tissue is involved in the inflammatory process, which leads to the development of phlegmon. If you are in the affected area of the lymph nodes, there is a risk of lymphadenitis.

When hydradenitis occurs in the genital area or the anus, complications manifest themselves in the form of fistulas of the bladder, urethra or rectum.

Treatment of hydradenitis
Hydradenitis is not a contagious disease, the patient does not pose a danger to others, therefore, if he observes the rules of personal hygiene, the treatment of hydradenitis is carried out not in a hospital, but on an outpatient basis.

Therapy of hydradenitis uses oral or intramuscular use of antibiotics (for complicated hydradenitis). The treatment is carried out for 7-10 days.

To alleviate the patient’s condition, other drugs are prescribed that reduce inflammation, eliminate skin irritation and relieve swelling. Immunostimulating agents are indicated for use to strengthen general immunity.

When treating hydradenitis, it is important not to allow the process to spread to neighboring sweat glands, and for this it is necessary to disinfect the skin, especially at the stage of infiltration. In the affected area and around it, the hair is carefully cut with nail scissors. Then the skin above the infiltrate is treated with antiseptics: iodine or an alcoholic solution of salicylic acid, ethyl alcohol. If the infiltrate has a large area and causes significant pain, then it is pricked with a solution of novocaine with antibiotics.

For three to five days, it is recommended to make only semi-alcoholic dressings for the treatment of hydradenitis. Bandages with ointments should not be used for hydradenitis, this can lead to maceration of the skin and the spread of the process. Treatment of hydradenitis and various compresses is contraindicated, as they increase infiltration and cause further suppuration.

In the treatment of hydradenitis, only dry heat is used by warming up with a blue lamp, a diaper heated with an iron, etc. In addition, in the treatment of hydradenitis, the doctor prescribes physiotherapy procedures, for example, UHF therapy, which reduces inflammation and helps to soften the infiltrate. But if a purulent cavity occurs inside the focus of inflammation, then warming procedures for hydradenitis cannot be carried out. In case of repeated occurrence of the disease, the doctor may prescribe X-ray therapy as a treatment for the destruction of sweat glands.

Mature hydradenitis is treated surgically. The usual autopsy of purulent hydradenitis and its drainage does not bring a positive result. At the same time, many microabsesses remain in the lesion, and their further maturation occurs. Surgical treatment consists in carrying out a wide incision passing through the infiltrate to healthy tissues. After complete evacuation of pus, the affected fatty tissue is removed. In case of repeated cases of hydradenitis, radical surgical treatment is required. At its first stage, the purulent focus is opened and the inflamed fiber is excised. After the inflammatory process passes, the skin and subcutaneous tissue are completely removed in the affected area. The resulting defect is closed with donor skin flaps of the patient himself

When treating hydradenitis, it is necessary to adhere to a diet. It is recommended to exclude sweet, flour, spicy and smoked dishes, alcohol from the diet, since these foods and drinks increase blood glucose, increase the inflammatory process, which can lead to complications.

In order to avoid the spread of infection to other parts of the body, it is necessary to observe the rules of personal hygiene in the treatment of hydradenitis. The patient should have individual bedding and underwear. It is forbidden to take a bath, you should use a shower instead, sealing the affected area with a waterproof adhesive plaster. During washing, soaping the body with bactericidal soap helps to reduce the number of bacteria on the skin.

Often, patients diagnosed with hydradenitis prefer to be treated with folk remedies: baked onions, cabbage leaves, flaxseed cakes. But such therapy is long-term and ineffective, it cannot be used as the main one.

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