Hydradenitis is a purulent inflammatory process that occurs in the apocrine sweat glands when a staphylococcal infection penetrates them. In most cases, the apocrine glands of the armpits are affected. But there may be hydradenitis of the umbilical region, inguinal folds, anus, scrotum, labia majora. The diagnosis of hydradenitis is carried out according to its characteristic clinical picture. For an adequate selection of antibiotic therapy, seeding of the separated with an antibioticogram is performed. Hydradenitis is dangerous with purulent complications up to the development of sepsis. Its timely and proper treatment allows to avoid such complications, but does not exclude the recurrence of the disease.
Hydradenitis is never observed in children and the elderly. This is due to the fact that the functioning of the apocrine sweat glands begins only by puberty and fades away in old age. Most of the diseases with hydradenitis (about 85%) occur in women aged 16 to 55 years. Most often, hydradenitis occurs during puberty, when hormonal imbalance occurs and in the menopausal period. Hydradenitis is based on various factors that lead to the development of an infectious and inflammatory process in the apocrine sweat gland.
Hydradenitis is a purulent disease of the sweat glands and belongs to pyoderma. The most common cause of hydradenitis is Staphylococcus aureus. The pathogen penetrates into the apocrine glands directly through their excretory ducts or through the lymphatic pathways through damage to the surface layer of the skin. Skin damage can occur during shaving, during epilation or when combing the skin due to itchy dermatoses. Constant wetting and maceration of the skin due to excessive sweating also leads to a decrease in its barrier function and the penetration of microorganisms.
The development of the infectious process in the apocrine gland occurs when the body’s defenses weaken. The occurrence of hydradenitis is promoted by: shifting the pH of sweat to the alkaline side, neglect of hygiene rules, endocrine diseases (disorders of the genital glands, diabetes mellitus, obesity), chronic inflammatory processes.
In most cases, hydradenitis is unilateral, but there are also bilateral lesions. At the beginning of the development of hydradenitis (infiltration stage), separate dense nodules of small size appear in the skin. They are accompanied by itching and mild soreness, which increases when pressing on the nodule. The nodules quickly increase in size and turn into large (up to 1.5 cm) dense pear-shaped nodes soldered to the skin. They protrude above the surface of the skin, resembling nipples. The skin at the site of the formation of nodes acquires a red-blue color, puffiness occurs, severe soreness is noted. Increasing, individual nodes of hydradenite can merge with each other, forming a spilled infiltrate of dense consistency, having a disc-shaped shape and similar to the phlegmon pattern. At the same time, severe pain is noted not only when the patient moves, but also at rest. The described clinical picture corresponds to the stage of maturation of hydradenitis. It is accompanied by general disorders: malaise, fever, severe pain syndrome.
In the future, there is a gradual softening of the central part of the nodes and the opening of the hydradenite with the release of pus, in its consistency resembling thick sour cream. Purulent masses may contain an admixture of blood. A feature that distinguishes hydradenite from a boil is the absence of a necrotic rod. The opening of the node of hydradenitis usually occurs 7-10 days after its occurrence and is accompanied by an improvement in the general condition and a decrease in soreness. An ulcer forms on the site of the opened node, which then heals, leaving behind a retracted scar.
The full cycle of development of hydradenitis takes about 2 weeks. But along with already scarring formations, nearby sweat glands involved in the inflammatory process can be suppressed. Hydradenitis takes a prolonged or chronic recurrent course, in which exacerbations can occur dozens of times. This is more often observed with untimely or inadequate treatment, non-compliance with personal hygiene and in patients with concomitant diseases that reduce immunity.
With hydradenitis, complications occur mainly in weakened patients or in the absence of treatment. The spread of the purulent process to the surrounding soft tissues without adequate drainage of the purulent focus leads to the formation of an abscess or the development of phlegmon. In the advanced stages of hydradenitis, a pyogenic infection can enter the bloodstream and spread throughout the body — sepsis occurs.
Diagnosis is carried out according to the characteristic clinical picture of hydradenitis. In a clinical blood test, signs of inflammation are noted: acceleration of ESR, increased white blood cell count. For adequate antibiotic therapy of hydradenitis, a separate bacposev is performed with the determination of sensitivity to antibacterial drugs. With prolonged and recurrent course of hydradenitis, the immune system of the body is examined — an immunogram.
It is necessary to differentiate hydradenitis from furuncle, lymphadenitis, tuberculosis of axillary lymph nodes, lymphogranulomatosis.
Patients with hydradenitis should follow a special diet. For 3 months, they need to abstain from spicy dishes, alcohol, seasonings, and limit the consumption of sweets. At the same time, nutrition should be aimed at increasing the body’s defenses. Vitamin-rich foods rich in phosphorus and iron are recommended: apples, carrots, berries, cabbage, citrus fruits, almonds, walnuts, rosehip, etc. Ingestion of multivitamin preparations, plantain juice or aloe, tincture of ginseng or eleutherococcus helps to strengthen immunity.
To prevent the spread of infection to other sweat glands, the skin around the foci of hydradenitis should be wiped 3-4 times a day with salicylic, boric or camphor alcohol. Since water can also contribute to the spread of infection, it is better to bathe in the shower, having previously closed the place of hydradenitis with a bandage with a plaster.
The general therapy of hydradenitis is carried out according to the principles of treatment of pyoderma, mainly with antibiotics (doxycycline, erythromycin, etc.) With recurrent hydradenitis, immunostimulating treatment is indicated, which is prescribed only according to the immunogram. When confirming the staphylococcal nature of hydradenitis, specific immunotherapy can be used: staphylococcal gamma globulin, staphylococcal vaccine.
In the stage of infiltration of hydradenitis, conservative therapy is indicated. Hair is cut in and around the affected area. The skin is treated over the infiltrate with antiseptics: 3% diamond green solution, 96% ethyl alcohol, 2% alcohol solution of salicylic acid, 5% iodine tincture, etc. If there is a large infiltrate with pronounced soreness, then it is pricked with 0.5-1% novocaine solution with antibiotics.
Semi-alcoholic wet-drying dressings are recommended for the first 3-5 days of hydradenitis. The use of bandages with ointments can cause maceration of the skin and contribute to the spread of the process. Treatment of hydradenitis with various kinds of compresses is contraindicated. It increases infiltration and accelerates suppuration. Only dry heat can be used in the treatment: a terry towel heated with an iron, 5-minute warming up with a blue lamp at a distance of 15-20 cm, solar warming up in the warm season (from 10 to 30 minutes, depending on the intensity of sunlight).
Mature (softened) hydradenitis is subject to surgical treatment. The usual autopsy and drainage of hydradenitis does not give a positive result, since its infiltrate is represented by a multitude of microabsesses, which, with such treatment, remain in the focus, continue to mature and produce pus. The opening of the hydradenite is carried out by a wide incision passing through the infiltrate to healthy tissues. After evacuation of pus, all infiltrated fatty tissue is removed.
With repeated recurrences of hydradenitis, its radical surgical treatment is performed. Surgical intervention consists of 2 stages. At the first stage, the purulent focus is widely opened and all inflamed fiber is excised. Wound healing takes place in open conditions and with mandatory antibiotic therapy. After the inflammatory processes subside and the appearance of granulations, the second stage of surgical treatment is carried out — complete removal of the skin and subcutaneous fat of the affected area with hydradenitis. The closure of the resulting defect is carried out by displaced flaps of the patient’s own skin (autodermoplasty). Radical surgical treatment of hydradenitis with a single-stage operation is not advisable due to the frequent suppuration of the postoperative wound after such interventions and its prolonged healing with the formation of a rough scar.
Of the physiotherapeutic methods of treatment prescribed by a physiotherapist in the stage of infiltration of hydradenitis, it is possible to use UHF, SMV therapy, local UVI therapy. However, some authors do not recommend any physiotherapy procedures at the beginning of the disease. After surgical treatment, local infrared irradiation, UVI therapy, laser therapy and magnetotherapy are used. In the treatment of recurrent and prolonged forms of hydradenitis, ultrasound therapy, electrophoresis with dionine, codeine or unithiol are prescribed.
With a persistent, repetitive course of hydradenitis, X-ray therapy can be used, during which the destruction of sweat glands occurs.