Hidradenitis Suppurativa
Picture of cysts and draining sinus tracts in the axilla which can be seen with Hidradenitis. Photo is attributed to Dermnetnz.org.
Overview:
Hidradenitis is an inflammatory condition that generally affects areas with abundant sweat glands such as the armpits and groin. The sweat ducts become plugged and ultimately rupture resulting in a significant inflammatory response which may result in pain, drainage, odor, and scarring. There is no cure for this condition but there are several management strategies to control or prevent your symptoms.
Over the Counter Treatments:
Bacteria may become over populated in the area leading to odor or super-infection of the sweat ducts which can contribute to your symptoms. These antibacterials may help.
Hibiclens -avoid contact with eyes and ears, flush immediately if contact occurs
Benzoyl Peroxide- 4% cream or wash, may bleach fabrics
Dilute Vinegar Spray (a natural antiseptic): Always dilute the vinegar prior to use. 2 Tablespoons in 1 cup water in a spray bottle. Apply to affected areas 7 mins before shower. Rinse off in shower.
Prescription Treatments:
Topical Clindamycin: Apply twice daily to affected regions in addition to one of the above OTC treatments.
Oral Doxycycline (100mg twice daily): Doxycycline is an antibiotic with anti-inflammatory properties. May have GI upset and sun sensitivity.
Oral Clindamycin and Rifampin (300mg twice daily): Take with a probiotic. Rifampin may lead to temporary orange discoloration of body fluids such as tears, sweat, and urine.
Oral Spironolactone (150mg daily): A diuretic with strong anti-androgen properties. May cause electrolyte disturbances or hormonal side effects.
Oral Metformin (500mg bid): may require lab testing
Injectable Humira: Humira is a biologic medication that blocks a specific inflammatory pathway in the body called TNF. It requires lab monitoring. It has potential side effects that can be discussed during your visit.
Modifying Factors:
Weight loss: weight loss will improve HS
Diet: avoid sugary foods and dairy products
Smoking Cessation: Smoking cessation will improve HS