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Monday, 22 October 2018

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.
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