Hidradenitis suppurativa is a rare condition characterized by a painful, discharging, chronic inflammation of the skin at sites rich in apocrine glands (axillae, groins, natal cleft).
Hidradenitis suppurativa is a chronic pyogenic infection of the apocrine sweat glands of the axillae, less so, of the breast, genitalia or peri-anal region. Hyperhidrosis, obesity, lack of fresh air, irritation by clothing, shaving, use of depilatories or the presence of intertrigo, are the predisposing causes; Staphylococcus aureus is presumably the causative organism.
The cause is unknown but it is commoner in females, and within some families it appears to be inherited in an autosomal dominant fashion. Clinically it presents after puberty with papules, nodules and abscesses which often progress to cysts and sinus formation. With time, scarring may arise. The condition follows a chronic relapsing/remitting course.
Clinically, it is seen as small, chronic, painful and tender nodules and discharging abscesses. The hairy cores of the boils are absent in the discharge. There is slight itching.
Treatment is very difficult but antibiotics, oral retinoids and co-cyprindiol ('2 mg cyproterone acetate + 35 µg ethinylestradiol' in females only) have been tried. They should be used as for acne vulgaris. Severe recalcitrant cases have been treated occasionally with surgery and skin grafting.
Treatment is unsatisfactory; but if due care is taken every patient can be helped considerably. The treatment consists in keeping the hair short and the affected part dry, bathing with patassium permanganate lotion, local application of gentian violet or tannic acid spiritous lotion, or Burrow's solution soaks, and the systemic use of penicillin or other antibiotics. In chronic cases, X-ray therapy may benefit, and in intractable cases, surgical excision and skin grafting may be necessary.
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