Hydradenitis – diagnosis and treatment

Hydradenitis is a disease that can cause a lot of unpleasant sensations. It often takes a recurrent form.Without timely treatment, hydradenitis can lead to serious complications such as abscess, phlegmon, sepsis and skin cancer.

What is hydradenitis

Hydradenitis is an inflammatory skin disease that develops in the apocrine sweat glands due to infection with staphylococcal microorganisms. It is most often localized in the armpits (usually in women), but it can also affect the groin area, the area around the navel, the anus and the skin next to the external genitalia (usually in men).

The disease is typical for people of childbearing age – from 15 to 55 years. It is during this period that the apocrine glands function most actively. Hydradenitis can take a recurrent form, that is, it can resume.

The symptoms of hydradenitis may vary, but the most characteristic feature is the appearance of painful nodules or abscesses in the area of the apocrine glands. These nodes may be red, swollen, and filled with pus. In some cases, purulent contents are released through the skin. The common name of the disease is "bitch's udder", it is associated with the characteristic appearance of purulent nodes.

Causes

Hydradenitis occurs due to infection with staphylococcal and streptococcal microorganisms that enter the body through the affected hair follicle. The blockage of the follicle contributes to the development of inflammation, which spreads to the apocrine glands. At the same time, provoking factors that contribute to the development of the disease play an important role:

• hypothermia or overheating of the skin;

• skin damage caused by shaving or hair removal;

• insufficient hygiene, and vice versa, excessive cleansing of the skin;

• chronic dermatoses.

Some studies indicate that smokers are more likely to suffer from axillary hydradenitis, and in these groups the disease may be more severe. Patients with autoimmune diseases, diabetes mellitus, decreased immunity, and overweight are also at risk.

Stages of development

Hydradenitis, as a chronic purulent disease, goes through several stages of development:

The first stage is the formation of single or multiple nodes, which usually do not cause pain or are mildly painful.

The second stage is an increase in the inflammatory process, which is limited to one location. During this period, recurrent nodules and abscesses occur, which do not merge with each other, but can open up, forming fistulous passages. This leads to the release of purulent-sucre contents, and some elements may become scarred.

The third stage is the most severe and is characterized by the fusion of inflamed nodes and abscesses. The softening process intensifies, many fistulas form, which communicate with each other, forming ulcers. After healing, these fistulas become scarred.

Treatment methods

Treatment of hydradenitis includes conservative and surgical methods. Conservative tactics include taking antibiotics, using local anti–inflammatory drugs, and maintaining hygiene in the affected areas. Physiotherapy is also indicated.

Surgical treatment is used in cases of ineffectiveness of conservative therapy and in cases of severe course of the disease. It includes the opening and drainage of abscesses, as well as the removal of the affected areas of the skin, followed by plastic surgery.

Indications and contraindications for surgery

The operation is performed in the following cases:

• Inflammation of the sweat glands with purulent contents. This is a dangerous condition, as pus can spread to nearby tissues and organs.

• Destruction of the apocrine sweat gland and formation of an abscess. An abscess is an accumulation of pus in a newly formed cavity, which can lead to serious complications if not eliminated in a timely manner.

• The lack of effect from conservative treatment, when medications and physiotherapy procedures do not work.

• Recurrent course of hydradenitis, when inflammation occurs repeatedly in the same place.

Contraindications to surgery are related to the patient's general health. For example, these may be severe systemic diseases or infectious processes in the acute stage.

Surgical treatment of hydradenitis

The choice of surgical procedure depends on the nature and stage of the disease. If hydradenitis manifests itself as a single abscess, the doctor performs an autopsy and installs drainage for the outflow of pus. This is a fairly simple procedure that is performed under local anesthesia and takes about 20 minutes. After that, the patient can immediately return home after it is completed.

With recurrent hydradenitis, when the inflammatory process occurs repeatedly in the same place, simple removal of the abscess and drainage will be ineffective. In this case, the surgeon additionally removes the sweat gland, which is prone to inflammation, and excises the nodes and fistulas. This operation is also performed using local anesthesia.

Postoperative care and prevention

In the first days after surgery, the patient needs to be provided with rest and limit physical activity. The wound heals within 2-3 weeks after opening, but this may depend on the individual characteristics of the body and the complexity of the operation. As a standard, patients are recommended to:

• maintain hygiene of the operated area to avoid possible secondary infection.;

• do not visit baths, saunas, pools and beaches until the wound is completely healed.;

• Avoid wearing tight and uncomfortable clothing that can chafe and irritate the wound area.

The doctor will also prescribe antiseptics to speed up the healing process and antibiotics to prevent complications.

To prevent hydradenitis, it is important to follow the rules of personal hygiene, take regular showers and use antibacterial products to cleanse the skin. It is also useful to avoid overwork, stress and hypothermia, which can serve as provoking factors for the development of inflammation.

List of sources and references

1. Tarasco A.D. Chronic deep recurrent pyoderma in the outpatient practice of a surgeon // Inpatient replacement technologies: Outpatient surgery. 2021. №2.
2. Piruzyan A.L., Nezpinskaya Z.A., Korsunskaya I.M. Skin bacterial infections are always an urgent problem. // MS. 2021. No.8.
3. Chu CB, Yang CC, Tsai SJ. Hidradenitis suppurativa: Disease pathophysiology and sex hormones. Chin J Physiol. 2021 Nov-Dec;64(6):257-265. doi: 10.4103/cjp.cjp_67_21. PMID: 34975118.


4. Jenkins T, Isaac J, Edwards A, Okoye GA. Hidradenitis Suppurativa. Dermatol Clin. 2023 Jul;41(3):471-479. doi: 10.1016/j.det.2023.02.001. Epub 2023 Apr 15. PMID: 37236715.
5. van Straalen KR, Prens EP, Gudjonsson JE. Insights into hidradenitis suppurativa. J Allergy Clin Immunol. 2022 Apr;149(4):1150-1161. doi: 10.1016/j.jaci.2022.02.003. Epub 2022 Feb 19. PMID: 35189127.