Hidradenitis suppurativa is a chronic inflammation of the skin characterized by the presence of blackheads and one or more red, soft lumps (lesions). Lesions often enlarge, open and secrete pus. Scarring can occur as a result after a number of relapses.

This condition is often considered a severe form of acne . Hidradenitis suppurativa occurs deep in the skin around the oil glands (sebaceous) and hair follicles . The affected body parts are usually the groin and armpits, which are also the main locations of the apocrine sweat glands

Synonyms of Hidradenitis Suppurativa also known as, acne conglobata, acne inversa, apocrine acne, Fox-den disease,

 

This disease occurs from puberty to young adulthood. The overall prevalence is around 1%. The ratio of women to men is 3: 1.

Smoking and obesity are risk factors for this disease . This disease is also often preceded by trauma or microtrauma, for example a lot of sweat, use of deodorant or clipped armpit hair .

 

Some bacteria have been identified in cultures taken from suppurative hidradenitis lesions , including Streptococcusviridans, Staphylococcus aureus , anaerobic bacteria ( Peptostreptococcus species, Bacteroi desmelanino genicus, and Bacteroides corrodens), Coryne formbacteria, and Gram-negative rods.

 

The initial complaints felt by the patient are itching, erythema, and local hyperhidrosis. Without treatment this disease can develop and the patient feels pain in the lesion.

 

Risk Factors

 

Smoking, obesity , sweating a lot, deodorant use, cutting armpit hair

 

Simple Physical Examination and Support Results (Objective)

Physical examination

 

A rash in the form of a node with signs of acute inflammation , can then be softened into an abscess, and break down to form a fistula and is called suppurative hidradenitis . In the chronic can form multiple abscesses, fistulas, and sinuses. There is leukocytosis.

 

Location of predilection in the axilla, groin, gluteal, perineum and breast area . Although the disease in the axilla is often mild, in the perianal it is often progressive and recurrent.

 

There are two classification systems to determine the severity of suppurative hidradenitis , namely the Hurley and Sartorius classification systems.

 

Hurley classified patients into three groups based on the presence and extent of scarring and sinuses.

 

Stage I : solitary or multiple lesions, characterized by abscess formation without sinus ducts or scarring.

 

Stage II : single or multiple lesions with recurrent abscesses, characterized by the formation of sinus tracts and scar tissue.

 

Stage III : the most severe stage, several interconnected channels and abscesses involving the entire anatomical area (eg armpits or groin).

 

Sartorius score. Scores are obtained by counting the number of skin lesions and the level of involvement at each anatomic location . More severe lesions such as fistulas are given a higher score than mild lesions such as abscesses. Scores from all anatomic locations are added to get a total score.

 

Differential Diagnosis

 

Furuncle , carbunkel , epidermoid cyst or dermoid cyst, Erysipelas , inguinal granuloma, lymphogranuloma venereum, scrofuloderma

Complications

 

Scarring at the lesion site.

Chronic genitofemoral inflammation can cause stricture in the anus, urethra or rectum.

Urethral fistula.

Genital edema that can cause functional disorders.

Squamous cell carcinoma can develop in patients with a long history of the disease , but is rare.

Comprehensive Management (Plan)

Management

 

Oral treatment:

 

Systemic antibiotics Systemic

antibiotics for example in combination with rifampicin 600mg daily (in a single dose or divided dose) and clindamycin 300mg twice a day show promising treatment results. The dosage is 50-150mg / day as monotherapy, erythromycin or tetracycline 250-500 mg 4x daily, doxycillin 100 mg 2x daily for 7-14 days.

 

Systemic corticosteroids Systemic

corticosteroids such as triamcinolone, prednisolone or prednisone

 

If an abscess has formed, an incision is made .

 

Advice for patient with Hidradenitis Suppurativa 

  1. Reducing weight for obese patients .
  2. Quit smoking.
  3. Do not shave on acne prone skin because shaving can irritate the skin.
  4. Maintain cleanliness of the skin.
  5. Wear loose clothing to reduce friction
  6. Bathing with soap and antiseptic or antiperspirant.

 

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