Pimples at the wrong site or recurring bumps? You may have hidradenitis suppurativa

In the afternoon clinic today, two young men with recurring foul smelling pimples and bumps and even pus at their armpits for years came seeking  for help. One of them has complicated sinus tracts (tunnels under the skin), scars and keloids (painful or itchy overgrown scars).

Contrary to popular beliefs, this really has nothing to do with personal hygiene or food. This is hidradenitis suppurativa, some called it acne inversa, caused by abnormal skin near the hair follicles blocking the sweat and oil glands. A condition that is really not fun to have and they tends to go to skin folds such as the armpits, under breasts and groin.

Hidradenitis suppurativa usualy start after puberty and may worsen over time. For some it can be nothing more than "an occasional pimple at odd location", for others it can be painful, affecting daily activities, destroying one’s self esteem and social life. Very rarely, people with severe uncontrolled disease can develop skin cancer (squamous cell carcinoma) at the affected area.






Being overweight, having hormonal disorders, smoking, living in hot and humid environment are among key factors that can worsen hidradenitis suppurativa. Wearing tight fitting clothes of irritating materials and shaving can trigger a flare-up as well. Hidradenitis suppurativa often happen in the same family.

Seek medical help early if you have this condition. Early diagnosis and early treatment not only reduces bumps and pain but also keep complications such as sinus tracts and scarring at bay.

Common treatments (depending on severity and individual condition) include,

• Antiseptics
• Antibiotics
• Steroid injection into a painful breakout
• Hormone therapy
• Immunosuppresantrs
• Oral retinoids
• Radiation therapy
• Laser treatment to destroy hair follicles
• Biologic (injections of genetically engineered proteins to block the inflammatory response)

Surgery may be required, such as

• Incision and drainage of the most painful 1-2 lesions, mainly for short term relief, but often the symptom will return
• Deroofing, turning a repeatedly return lesion into a scar
• Excision, cutting out the affected area and closed by skin flap or skin graft

 
People with hidradenitis suppurativa may feel anxious or depressed. Patient support group is available in Malaysia. You can reach their Facebook page here.

100 Years of Illegal Beauty Products

Interesting video! How far would you go for beauty?

It was once illegal to makeup below 44 years old.

Oh, and thank goodness you don't have to take the risk of getting blind to remove some facial or upper lip hair. Easily and safely done with a quick 5 minutes laser.  ;P

100 Years of Acne Treatments

From 1910s to 2010s.



A lot are still in use and proven effective over time, such as topical retinoids from 1970s and oral retinoids in 1980s.





My favourite is 2000s' acne extraction and cortisone shots. What about you?

Telemedicine, Blindmen and the Elephant

We all know face-to-face consultation in the clinic is the best. However sometimes it is not possible, due to distance etc. Consultation over phone calls, emails, social medias and even proper telemedicine platform such as TELEME has a lot of limitation especially when it comes to dermatology. Not just because I cannot see the skin clearly but also because I cannot examine it.

To be honest, a lot of times, I feel like a blind man. Asking many questions rather than answering. How accurate and relevant my guess and advice is depends very much on whether the person on the other end decided to let me know the tail, the horn or whichever part of the elephant. And as a doctor, we have to be responsible for the advice we dispense.

Despite the best reasonable effort, many times I still can't be sure that I am getting the full picture of what the patient's true problem is. The information are often distorted. Worse still is that some people are asking questions on behalf of someone else. And expecting me to offer one miracle cream that will solve their problems through a blur picture, not even revealing which body part that picture belong to.

As my ex-colleague and friend put it, blind man touching part of an elephant + wearing a thick gloves.

Anyway, I must say Telemedicine is not without it's benefit, probably best general enquiry for non-medical person, or for second opinion among healthcare personnels, hopefully and likely we will be speaking the same "language".