What Is Hidradenitis Suppurativa?

Purulent sweat glanditis is a chronic purulent inflammation of the apocrine sweat glands, which mainly occurs in the armpit, external genitalia, and perianal area. It occurs in young and middle-aged women, and may be related to the more developed female sweat glands.

Basic Information

English name: Hidradenitis Suppurativa
Visiting department: dermatology
Multiple groups: Young and middle-aged women
Common locations: Underarms, external genitalia, and perianal

Common causes: Staphylococcus aureus or Streptococcus pyogenes and other Gram-negative infections
Common symptoms: Hard subcutaneous nodules, conscious pain and tenderness, deep nodules purulence, ulceration to the surface, pea-sized hard nodules, etc.

Causes of purulent sweat glanditis

The pathogenic bacteria are mainly Staphylococcus aureus, and may also be infected with Streptococcus pyogenes and other Gram-negative bacteria, which mostly occur in young and middle-aged women, and may be related to the more developed female sweat glands. Sweating more, dirty skin, friction, scratching, etc. can be the cause of this disease. Shelly et al. Gave a local closed bandage to the axilla of normal subjects to impregnate the skin, which can cause purulent damage. Therefore, they believed that the immersion of the axillary site caused keratinous obstruction of the parotid sweat glands and caused local infection. Other causes include excessive androgen, endocrine diseases, immune dysfunction, obesity, smoking, etc. This disease can coexist with concomitant acne and abscess puncture folliculitis, which is called triad of hair follicle atresia, and is autosomal dominant.

Clinical manifestations of suppurative sweat glanditis

Axillary sweat glanditis

It starts with one or more small, hard subcutaneous nodules. Later, new rashes appear in batches, arranged in strands, or clustered into large patches. Nodules may be absent on the surface of the nodule. Occasionally, a small pustule appears on the top of the nodule, and the pain and tenderness are conscious. The general symptoms are mild. After a few weeks or months, the deep nodules of the nodules will rupture to the surface, forming a wide fistula and larger than young and middle-aged women, which may be related to the more developed female sweat glands. If it is not treated, it can occur from time to time, showing a chronic process. Approximately 20% of both axillary affected

2. External genitalia, perianal sweat glanditis

It is often concurrent with or subsequent to axillary sweat glanditis, but it can also occur first. It is more common in men and is often accompanied by polymeric acne. Initially, pea-sized hard nodules occurred in the groin, scrotum, femur or buttocks, and around the anus, and they quickly ulcerated, forming a latent ulcer. There are fistula tracts connected to each other, which can penetrate to the anal wall to form anal fistula. Female areola can also be affected. Most blackheads can be seen in the armpits, anus, or genital area, which is of diagnostic significance. Its course is more stubborn than axillary sweat glanditis and can last for many years.

Suppurative sweat glanditis examination

Histopathological examination, early hair follicle horn plugs and gradually ruptured hair follicles, infiltration of neutrophils around the apocrine sweat glands and their dilated ducts, Gram staining of a large number of cocci in the glands and dermis, and small sweat glands also invaded. There was a large amount of lymphatic infiltration around the blood vessels and infiltration of plasma cells. Finally, the glands were destroyed, and foreign body giant cells infiltrated around the glandular epithelial fragments. Extensive fibrosis was seen in the healing area, and all skin attachments were damaged.

Diagnosis of suppurative sweat glanditis

According to the occurrence of hard nodules, latent ulcers, traffic fistulas, and the occurrence of axillary and groin areas, typical cases are not difficult to diagnose.

Differential diagnosis of suppurative sweat glanditis

It needs to be distinguished from cutaneous TB, groin granuloma, STD lymphogranuloma, and syphilitic lymphadenopathy. Bacterial and serological tests can be performed, and biopsy can be performed if necessary.

Purulent sweat glanditis treatment

General processing

Keep local skin dry and clean, and avoid friction, scratching and other irritation.

2. Systemic Therapy

Early acute damage can be treated with short-course antibiotics, such as daily tetracycline, or minocycline, for a total of 10 days to obtain results. Refractory patients can be treated with antibiotics for a longer period of time.

Glucocorticoids such as prednisone, for a week. Intradermal injection of glucocorticoids may be effective for a short time. Severe sweat glanditis, which is ineffective for antibiotics and glucocorticoid therapy, and is not suitable for surgical resection, Ebling found that treatment with chlorprodone acetate as a testosterone antagonist for 2 to 3 months, the damage completely subsided. Isotretinoin, used for 4 to 6 months, can improve the response of about 1/4 patients.

3. Local treatment

The local part should be kept clean and hygienic. The affected area can be cleaned 2 or 3 times per day with 0.1% ethacridine solution, 0.5% neomycin solution or purslane decoction. Generally try not to cut open drainage, for mature abscesses, cut open drainage. In addition, shallow X-ray treatment can also be used. For cases of refractory repeated recurrence, extensive surgical resection of the skin and subcutaneous tissue at the lesion can be performed concurrently with skin grafting, but surgical treatment is not recommended for the groin and sub-breast folds.

4. Chinese medicine treatment

In the acute attack period, mainly heat clearing and detoxification.