Hidradenitis under the arm and other locations. Causes, signs, treatment

One of the most dangerous skin diseases requiring medical attention is hidradenitis, an inflammation of the apocrine glands. The most common period of occurrence of the disease is puberty and old age.

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When microbes enter the apocrine glands, a large abscess develops, inside of which there is liquid pus. Unlike a boil, hidradenitis does not have a necrotic core and is more like a phlegmon.

Causes of hidradenitis (axillary, inguinal and other localizations)

The main triggering factor for this pathology is personal untidiness. If a person ignores the rules of personal hygiene and does not take a shower or bath in a timely manner, the skin becomes a favorable environment for the rapid growth of microorganisms, including Staphylococcus aureus. In recent years, the main cause of suppuration of the sweat glands in the axillary and groin areas is shaving. Microcuts that occur during hair shaving become entry points for infection.

In addition to uncleanliness, obesity plays an important role, due to which the folds of the skin do not dry out in a timely manner (in a humid environment, microbes multiply tens of times more actively). Diaper rash and scratching also reduce the protective functions of the skin. Finally, diabetes mellitus, which impairs the nutritional function of blood vessels, is also a favorable background for the development of purulent skin infections.

The use of antiperspirants is based on blocking the function of sweat glands. Because of this, sweat does not flush their ducts, Staphylococcus aureus is not washed out and inflammation develops in the sweat gland itself.

Therapy for inflammation of the sweat glands

The disease is dangerous due to serious purulent complications, including the development of sepsis, so treatment of the symptoms of hidradenitis and elimination of the pathogen must be timely.

At the initial stages of the pathology, conservative therapy is successfully used, which consists of enhanced antiseptic treatment of the damaged area of ​​the skin, exposure to dry heat, and ultraviolet light. To prevent further development of the disease, local antibacterial ointments and gels, application of bandages with an anti-inflammatory effect, as well as systemic antibacterial drugs are prescribed.

Where does hidradenitis occur?

Typical localization is the axillary region (the same in both women and men), hidradenitis in the groin (in women more often due to shaving of the intimate area), in the areola of the nipple and under the mammary glands. Hidradenitis genitalis occurs less frequently (in men - the scrotum, in women - the labia majora), as well as on the face (mainly in men).

Such localizations are due to the fact that apocrine sweat glands located in these places are most often susceptible to inflammation. Their peculiarity is the tortuosity of the ducts, which impairs the outflow of sweat and contributes to its inflammation when Staphylococcus aureus penetrates into the gland.

2. Reasons

Hidradenitis in most cases is caused by Staphylococcus aureus (sometimes streptococci, Escherichia coli, pseudomonas, etc. are identified as the causative agent). The predominant route of penetration into the apocrine gland is lymphogenous; Often the source of infection is an infected hair follicle. The most significant risk factors are:

• female gender (women have significantly more apocrine glands);
• microtrauma of the skin due to shaving, hair removal, etc.;
• scratching, diaper rash, abrasions, irritation and other skin lesions that facilitate the penetration of bacterial infections;
• endocrine and metabolic disorders, especially accompanied by obesity, sweating, increased humidity and oily skin;
• weakness of the immune system due to one reason or another (general exhaustion, previous abdominal surgery, hypovitaminosis, etc.).

It should be noted, however, that most often the immediate cause is a simple failure to comply with the rules and procedures of aseptic hygiene.

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Stages of the disease hidradenitis

There is no clear stage in the development of the disease. It all starts with the appearance of a painful small nodule under the skin in a typical location. It is not visible at first, but can be felt. After 24-48 hours, it increases significantly in size, the skin over it changes color to red, and then to purple-bluish. The pain becomes very severe and often prevents active movements of the limb.

At this moment, in the thickness of the node there is a process of tissue melting, which is manifested by the appearance of fluctuations (when you feel the node, you feel that its center seems to fall under your finger). The skin over the abscess gradually thins until a small hole appears in it, through which thick pus begins to flow. This usually occurs 7-10 days from the onset of the disease. Often, in the absence of treatment for hidradenitis suppurativa, the process ends in the formation of a fistula, through which serous-purulent contents constantly leak.

Subcutaneous tissue is penetrated by a large number of lymphatic vessels. Through them, the infection can spread to neighboring sweat glands. In this case, the general condition of the patient may also suffer. Symptoms of chronic hidradenitis: body temperature rises, fatigue, weakness appear, sleep and performance are disturbed. Due to massive infection, the subcutaneous tissue swells greatly, foci of infection protrude above the skin, which together forms a picture similar to a “bitch udder” (this has become the popular name for the disease).

Preparation, diagnostics

Upon examination, the surgeon differentiates hidradenitis from other purulent lesions of the skin and soft tissues and determines the stage of the disease. For adequate antibiotic therapy, bacterial culture of purulent discharge is carried out to determine microflora and sensitivity to antibiotics. For prolonged and recurrent pathologies, an immunogram is prescribed. Surgical intervention does not require specific preparation. All you need to do is pass a standard package of tests. Thanks to our own laboratory, the answers will be ready within an hour, after which the surgeon will carry out the treatment.

Treatment of hidradenitis

At the stage of infiltration formation, the doctor may try to treat hidradenitis in the groin area, armpits and other locations conservatively. On the first or second day, the use of local remedies is recommended. Antibiotics for hidradenitis are used in the form of ointments, most often tetracycline, erythromycin ointments, and clindamycin lotions are used. Since it is most often impossible to cure acute hidradenitis with conservative methods, it is necessary to resort to surgical intervention.

Adequate outflow is a key point in the treatment of any purulent process. Hidradenitis surgery is the best way to achieve this. According to surgeons, the most appropriate method of pain relief is anesthesia. This avoids systemic effects from anesthetics that would have to be administered in too large quantities.

Progress of the operation:

1. The skin above and around the abscess is treated with antiseptics.
2. A small incision is made throughout the entire depth of the skin until the abscess cavity is opened.
3. The cavity is treated with antiseptics, then drained with gauze turunda soaked in water-soluble antibiotic ointment.
4. With multiple lesions of the sweat glands, each abscess is opened immediately. If the lesions are located very close to each other, it is better to remove the entire inflammatory conglomerate within healthy tissue. In this case, the wound is sutured. In all others, it heals on its own.

After the operation, daily dressings are performed, during which the skin around the wound is treated with antiseptics. They also wash the abscess cavity, change the turundas with ointment. At the end of the dressing, bandages with antimicrobial ointment are applied to the wound.

Turunda is removed after pus stops flowing from the wound. After this, it quickly heals on its own. Of course, until complete healing, dressings continue.

General conservative treatment is usually carried out after surgery in cases where hidradenitis recurs (some call this form of the disease chronic, which does not reflect its actual course) or many sweat glands are affected. In this case the following applies:

• courses of antibiotic therapy with cephalosporins and semisynthetic penicillins;
• transfusion of antistaphylococcal plasma;
• UV irradiation of blood;
• laser irradiation of blood;
• vitamin therapy.

For severe pain, non-narcotic analgesics are prescribed; for sleep disturbances, appropriate sleeping pills are prescribed.

Indications for surgery

Indications for surgical treatment are:

• the formation of a painful inflammatory-purulent infiltrate in the armpit, near the navel, on the labia, in the inguinal fold;
• destruction of the apocrine gland with the formation of an abscess;
• recurrent hidradenitis.

The decision on the possibility of surgical intervention on an outpatient basis is made by the surgeon based on the characteristics of the clinical situation. In some cases, hospitalization may be required.

Possible complications after laser treatment of hyperhidrosis and contraindications

Some patients notice enlarged lymph nodes after surgery. This is possible if the lymphatic system was affected during the procedure. This complication goes away within a month.

Sometimes there is a decrease in skin sensitivity in the armpits. This is a reversible reaction caused by the destruction of nerve endings by a laser scalpel.

The lack of effectiveness of such treatment for hyperhidrosis in some cases can be explained by the anatomical features of the body, which is capable of partially restoring the destroyed sweating system. In such cases, symptoms return a few weeks after surgery.

If a specialist prescribes laser treatment for excessive sweating, there is no need to refuse: this therapy is not dangerous, painless, and the positive result will be dry armpits and feet, which will no longer cause an unpleasant odor.

To avoid serious negative consequences, contraindications to the procedure should be taken into account.

The main contraindications for laser treatment of sweating include:

• Age up to 18 years.
• Inflammatory processes of the sweat or sebaceous glands in the area of ​​interest.
• Dermatological diseases, allergic rashes in the intended area of ​​influence.
• Acute infections.
• Oncological diseases.
• Diabetes mellitus in the stage of decompensation.
• Blood diseases, bleeding disorders.
• Pregnancy and lactation period.
• Regular use of certain medications (to reduce blood clotting, steroid hormones, and drugs with a photosensitizing effect).

Components included in medications can provoke the occurrence of photosensitivity. A list of such drugs can be found in open medical publications. Some of the most common in this category are antibiotics, anti-inflammatory drugs, and hormonal contraceptives.

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Are there any complications?

If the immune system is weak and the body is not provided with professional support, the disease will develop and there are risks of complications. In this case, these are inflammation of the lymph nodes, abscesses, scars, sepsis, meningitis, inflammation of internal organs and even thrombosis of cerebral vessels. That is, theoretically, things could lead to complications that would be dangerous not only to health, but also to human life. So the symptoms of pyoderma should never be ignored. This is not just an aesthetic problem. Moreover, against the background of the aesthetic factor, severe psychological conditions can develop, even depression - so this point also cannot be ignored.

Features of treatment in children

Treatment of hidradenitis in children is carried out comprehensively. If there are no signs of general malaise, it is possible to limit yourself to local measures.

• Surgical opening of the pustules is performed, followed by treatment with antiseptic agents.
• Ultraviolet irradiation of the affected area of ​​the skin is prescribed.
• To stimulate the immune system, immunomodulators and massive doses of vitamin preparations are used. In addition, specific antistaphylococcal immunoglobulins and vaccines are widely used in our clinic. A safe treatment method with virtually no contraindications is autohemotherapy.
• If the course of hidradenitis becomes chronic, the doctor at our clinic conducts a detailed examination of the child to identify chronic diseases or metabolic disorders.
• Local treatment can be either conservative or surgical. In the latter case, the purulent focus is opened to healthy tissue and the cavity is thoroughly washed.

During the recovery period, the child needs rest and a high-calorie, balanced diet rich in vitamins and microelements.

The prognosis of the disease if you seek help in a timely manner is usually favorable. In the future, you must remember to observe the rules of personal hygiene.

Diagnostic methods in surgery:

• Doppler in surgery
• Colonoscopy
• Angiography
• CT scan
• Gastroscopy
• MRI
• Abdominal ultrasound
• X-ray
• Endoscopy

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How much does laser treatment for hyperhidrosis cost?

Today, laser treatment of armpit hyperhidrosis is the most effective among all possible methods of getting rid of sweating. Almost all cosmetology clinics in Russia and many more widely targeted private institutions are equipped with appropriate equipment and can provide laser therapy services.

The cost of treatment depends not only on the professionalism of the surgeon, the reputation of the center and the conditions of the operation, but also on the region. The average price for laser treatment of hyperhidrosis in Moscow is about 40 thousand rubles. In other regions, the cost of laser treatment for hyperhidrosis is somewhat cheaper - about 25-30 thousand rubles.

The result of therapy largely depends on the qualifications of the surgeon, so we strongly recommend that you contact doctors who have not only the appropriate certificate, but also certain experience. First study the reputation of the clinic, its specialists, the conditions for the procedure, and then make an appointment.

Nowadays, you no longer have to spend a lot of time performing complex and unpleasant procedures at home. It is much easier to seek help from real professionals - the Veronika Herba beauty and health center, equipped with effective and modern equipment.

Why clients choose Veronika Herba beauty and health center:

• This is a beauty center where you can undergo laser treatment for hyperhidrosis at a reasonable cost, while your body will be treated by one of the best specialists in Moscow. This is a completely different, higher level of service!
• You can receive qualified help at any time convenient for you. The beauty center is open from 9:00 to 21:00, seven days a week. The main thing is to agree with your doctor in advance on the date and time of your appointment.

Sign up for a consultation with a specialist by phone +7 (495) 085-15-13

, and you will see for yourself!