Hydradenitis: symptoms, treatment, cautions
It's not for nothing that they say that "the people will tell how to tie up".The name of hydradenitis, one of the most common purulent diseases, is proof of this.Being called with the light hand of patients with a "bony udder," it does resemble the bitch's nipples during the feeding period.This concludes the similarity.
Hydradenitis is a purulent inflammatory process affecting the apocrine sweat glands. Concise educational program: apocrine - these are the glands in which secretions of the secreted secret "fall off" parts of cells;Sweat glands belong to the "family" of these glands.
Usually, hydradenitis develops in the armpit, less often in the inguinal region.There were cases when the abscesses of the sweat origin were strewn with an area around the nipples, large labia in women, the scrotum in men and even the skin around the anus.Contents: Hydradenitis: causes of development Predisposition to the disease, factors triggering its onset Clinical manifestations Differential diagnostics Options for the course of hydradenitis Conservative treatment of hydradenitis Operative treatment of hydradenitis Treatment with folk remedies Possible complications of hydradenitis Prevention of disease
Hydradenitis: causes of development
All existing purulent pathologies in the world are similar to each other in that they are caused by infection.Basically, hydradenitis can be provoked by staphylococci and streptococci.Once on the skin and gradually spreading through it, a cluster of bacteria stumbles onto the hair follicle, through its mouth( anatomical passage) is introduced into the excretory duct of the sweat glands( rarely penetrates here with blood flow or from neighboring tissues).
In the closed space of the sweat gland, bacteria get into conditions that are ideal for the life of most living organisms: warm, dark, moist, "quiet"( not from the point of view of soundproofing, but chemical and physical "silence"There is, the stability of the environment without a "cataclysm" and changes). Almost immediately in such conditions, bacteria begin to multiply intensively, the number of them is growing rapidly.
This process causes a natural response of the body - a cluster in a place of high concentration of foreign agents( which are bacteria) cells of the immune system. The resulting pus is the dead bacteria and leukocytes involved in the fight against them. Due to the fact that the sweat gland has limited space, and the pus continues to accumulate - it swells, its cavity unfolds with purulent contents, the walls of the cavity become thinner, the skin in the projection of the gland also thins out, pus-like, becomes shiny - this gives the abscess the appearance of the nipplesDogs during feeding.
Predisposition to the disease, factors provoking its onset
All of us live not in a sterile environment, but not all suffer from hydradenitis. is more likely to be affected by patients with :
- Weakened general condition( after injuries, surgeries, especially cavitary, chronic diseases, in particular, after transferred or against the background of the current infectious pathology - hydradenitis then acts as a secondary infection);
- excessive sweating( for example, due to the physiological characteristics or diseases of the autonomic nervous system that regulates the secretory glands);
- deviation in the alkaline side of the sweat composition;
- decrease in body resistance( immune system diseases);
- significant excess weight( in obese people it is more difficult to conduct a full hygiene of the folds of the body, formed due to fat deposits).
Directly the occurrence of hydradenite is provoked by:
- non-observance of the elementary hygienic rules ( armpits, anus, inguinal folds are conditionally closed areas, so ideal conditions for survival of the pathogenic agent are created here) ;
- maceration( erosion of the skin in conditions of high humidity - for example, due to rubbing tight jeans worn in the heat);
- microtrauma( combing and, as a result, microdamaging of the skin with scabies, itching( in patients with diabetes, itchy dermatoses), cuts with inept or inaccurate shaving).
It's interesting that adults suffer from hydradenitis - because the apocrine sweat glands develop rather late, during puberty. Girls begin to get sick earlier and suffer more often than boys.
Another interesting fact: during withering( in elderly people and elderly people) the function of the apocrine glands is also fading, therefore, from 55-57 years old and older, hydradenitis is not detected. Clinical cases have repeatedly been described, when people, during the adult period regularly suffering from the "bony udder", in advanced age, even against the background of a weakened immune system, a complete spontaneous( without any medical measures) recovery.At the same time, they did not experience a single relapse until the end of their life, although these people had been tormented for a long time because of periodically occurring hydradenitis.
It is not difficult to diagnose hydradenitis on the basis of clinical manifestations( complaints and examination data). According to clinical manifestations, these stages of hydradenitis are distinguished:
- suppuration and rejection of pus;
At the infiltration stage, patients feel a slight soreness at the site of the lesion, which, if no medical measures have been taken, is rapidly growing.The intensification of pain was provoked by squeezing the nerve roots with inflamed swollen tissues, and later with pus.The middle density and soreness of the nodules are felt, which are not deep.
After 1-2 days from the onset of the disease, the swelling of the tissues is already visible, they are hot to the touch - pus is formed, the stage of suppuration begins( and after 24-36 hours - and rejection of pus).With the progression of the purulent process, the tissues begin to bulge in the form of nipples( the tops of individual ulcers), the skin around these foci become hot to the touch, red, closer to the focus - with a cyanotic ebb.
When the ulcer is ready to self-hide, the skin in this place is thinned and acquires a specific whitish color and shine.When generalizing( spreading), individual abscesses merge into a single whole.When the pus no longer fits in the cavity, the refined skin breaks, the purulent focus is self-enclosed, the patient feels a sharp fade-out of pain, comes subjective relief.There is pus, like thick sour cream, with an admixture of blood.Necrotic rod is absent - purulent masses are homogeneous.
After cleansing the cavity of pus( with medical care and much less spontaneously), the scarring stage begins - the cavity is filled with a connective tissue that performs it from the inside out and "crowns" the scar. In cases without complications from the onset of the disease to complete scarring, it can take 8-12 days.
Hydradenitis externally and according to subjective sensations of the patient is similar to a furuncle( an abscess of a hair sac), but, unlike a furuncle, with this disease a necrotic stem is not formed.
Sometimes hydradenitis can be confused with collicative skin tuberculosis, in which also initially there are thickened tissues in the form of nodules and subsequent suppuration.But collibacative tuberculosis is characterized by a longer duration, as well as a more gradual development of the process into which lymph nodes are drawn in and which ends with the formation of multiple ulcers, fistulas, and characteristic bridging scars.Kollikvativny tuberculosis is confirmed by the identification of a stick of Koch.
With atheroma hydraenitis is difficult to confuse, because the content of atheroma is curdled, and not creamy, larger in size, it bulges out of healthy tissues in the form of a single cone rather than a few small nipples, usually not characterized by signs of inflammation.
Options for the flow of hydradenite
In a number of cases, the hydradenite does not pass from the stage of infiltration into the purulent stage. Because of the timely immune response, the process in the tissues is suspended, and then develops completely in the opposite direction: redness, pain, swelling of the tissues disappear. The seal remains on the lesion site, which eventually disappears.With the repeated action of provocative factors, the process can be started again, in this case often develops faster, resulting in the formation of a full abscess and the rejection of its contents.
There is another variant of the course of hydradenitis, when purulent changes migrate from sweat glands to surrounding tissues.Those become similar to phlegmon - there is a dense( to the touch, like a wooden board) swelling of the tissues without clearly formed separate abscesses, with pronounced soreness. Due to the generalization( spread) of the infectious process on the tissues, the general condition of patients with such symptoms as
- increases in body temperature( up to 38-38.5 degrees Celsius and above);
- dry mouth;
- general weakness and malaise.
If the immune system is weakened, then after the healing of hydradenitis, its relapses( repetitions) are possible - in most cases in the same place where hydradenite was observed for the first time. By the presence of relapses, it is possible to suspect impairment by immunity and send the patient to a more detailed examination, continuing to treat the local process.
Conservative treatment of hydradenitis
At the stage of infiltration, if there are no symptoms of pus formation, hydradenitis is treated conservatively. This applies:
- antibacterial drugs that are taken orally, although with a widespread or repetitive process, you can be reinsured by prescribing them injectively;Such drugs are prescribed, based on the sensitivity of the causative agent of the disease;
- dry heat locally;
- physiotherapeutic procedures aimed at reverse development of infiltration( UF, UHF, SHF);
- desensitizing preparations - promote the action of antibacterial agents, reduce the sensitivity of the organism, including, and to the toxins of the pathogen;
- vitamin therapy - preferably injectable.
At this stage, if nothing indicates its transition to the suppuration stage, therapy can be received on an outpatient basis - the clinic should be visited only for certain procedures, the rest of the time it can be at home. At the same time, it is necessary to establish the correct process of hygienic procedures - first of all, not to wet the affected area.
In case of relapses( not necessarily frequent and prolonged), the correction of the immune system functioning is shown - but not only medicamentous. In the fight against relapse, general health promotion methods that should not be ignored are also successful:
- vitaminized food;
- hardening( only not at the time of relapse - douche, walrus and other methods of hardening are contraindicated not only at the stage of suppuration, but also at the stage of infiltration);
- physical activity;
- ejection of chronic sluggish infectious diseases, which significantly weaken the immune system.
Operative treatment of hydradenitis
At the stage of suppuration, immediate surgical treatment is indicated.In surgery, the reinforced concrete rule is cultivated: "If there is pus - it needs to be removed". If you ignore this postulate and rely on conservative methods of treatment, pus( and not only the pathogen) can "run up" through the body.
Patient under local anesthesia undergoes an operation to open the abscess. If the pus spreads deep into tissues, and if there is a process in the sensitive area( for example, around the nipples, anus, near the scrotum) and personal hypersensitivity of the patient, an abscess can be opened under anesthesia( intravenous). The operation scheme is as follows:
- layered dissection of the abscess wall;
- thorough sanitation( cleaning) of the abscess cavity to remove purulent clusters with maximum cleaning of the most secluded corners( pockets) of the cavity;
- treatment of the cavity with antiseptics;
- Drying with sterile material;
- drainage( immersion in the abscess cavity of tubes or rubber strips, through which the remains of antiseptics and pus that can still be produced according to the "residual principle" will flow out from the postoperative wound);
- application of an aseptic dressing.
The operation is simple, it can be carried out in a purulent dressing room both in the outpatient surgical room and in the surgical hospital.
After the opening of the abscess, a dressing is done every day - the sanation of the postoperative wound with the help of antiseptics and the change of the bandage.If the process was extensive, with a large amount of pus, accompanied by a general symptomatology, then in the first 2-3 days dressings can be done twice a day.They are carried out until the cavity is made with a connective tissue.Also, a careful toilet of surrounding tissues is conducted in parallel.
After opening of relatively small ulcers, the patient can return home the same day and visit a polyclinic( hospital) for dressings and other procedures.With large abscesses, accompanied by worsening of the general condition, it is better to be on inpatient treatment for at least 1 week after surgery.
In surgical treatment of hydradenitis, conservative methods are not ignored, but they are already used as auxiliary ones:
- antibacterial drugs - prescribe to prevent the pathogen from spreading to surrounding tissues and cause complications;
- desensitizing agents;
- Vitaminotherapy - injections of vitamins, first of all, of group B to accelerate the healing of the postoperative wound.
In the presence of an abscess, physiotherapy( UHF, UHF, and so on) is categorically contraindicated. But there is a borderline between the stages of infiltration and suppuration, which can not be caught either by inspection or based on the patient's complaints.In such cases, 1-2 physiotherapy procedures are prescribed: the process of suppuration is inevitable anyway, and the physical procedure only "pushes" it, actually shortening the time of the illness.But such "cunnings" can only be used by surgeons under their vigilant supervision.If after physiotherapy sessions symptoms of suppuration are clearly observed, the patient immediately undergo an operation to open the abscess.
Treatment with folk remedies
Traditional medicine has many ways of conservative treatment of hydradenitis - in particular, its moderate "warming up" in many ways( the effect is equivalent to the effect of physiotherapy procedures).Such methods can be used in the initial stages of hydradenitis, when there is a slight manifestation of symptoms: insignificant compaction of tissues, slight reddening, slight soreness.
Let's repeat the most important postulate of purulent surgery: if there is pus, then it must be immediately removed from the body.Contrary to the assurances of people "versed" in folk methods, the only method effective is the surgical one. Do not practice applying lozenges that contain different ingredients( including shredded foods).Some folk remedies, due to the difference in osmotic pressure, can "pull out" the liquid - but if the pus hides in the thickness of the tissues, then this possibility is very doubtful.Moreover, without medical knowledge you will not be able to assess the scale of purulent lesion.
At the first signs of the appearance of pus, it is strictly forbidden to "warm up" or squeeze out an abscess - you should immediately seek help from a surgeon. The use of antibiotics without surgery( and even more so without systemic pharmacological knowledge) will not only not help, but it will also hurt. Do not self-medicate!
Even if there was a spontaneous dissection of the abscess - still do not hesitate to contact the surgeon.The cavity of the abscess is not cleaned from the pus, without deep sanitation with the use of antiseptics can not do.
Possible complications of hydradenitis
If hydradenitis is allowed to go by itself, hoping for self-healing, or treated inappropriately( including pseudo-ways "from a neighbor") - it can cause a number of complications. First of all it is:
- generalization( propagation) of the process - the causative agent goes "beyond" the sweat glands and spreads around the surrounding tissues both in breadth and in depth, through the connective tissue lintels, tendons, fascia "fading" quite far from the primary focus and "scattering"Organism secondary infectious foci; is especially dangerous if the purulent process affects the periosteum and bone tissue - such a disease is called osteomyelitis, very difficult to treat fistula;
- lymphadenitis - inflammation of the lymph nodes located near( in the first place - axillary and inguinal) due to penetration into them of the pathogen;Further damage to the lymphatic system is fraught with lymphostasis( elephantiasis);
- in far-reaching cases - infection of blood( sepsis).
Prevention of disease
In fact, it is much easier to prevent hydraenitis than to treat it later. You just need to exclude the reasons that lead to it:
- not to allow the weakening of the general condition of the body;
- to eliminate the causes of hyperhidrosis;
- monitor the condition of the immune system;
- observe hygienic rules, keep areas that are problematic in terms of occurrence of hydradenitis( armpits, inguinal areas, nipples, large labia, scrotum, anus);
- do not allow rubbing and irritation of the skin in conditions of high humidity - for this purpose wear comfortable clothes made of natural fabrics;
- avoid micro-injuries( do not comb the skin with dermatoses and diabetes, shave the hair in the problem zones as accurately as possible, if the process does not work and there is no desire to refuse shaving bothersome hair - instruct depilation specialists in beauty salons).
Kovtonyuk Oksana Vladimirovna, medical reviewer, surgeon, consulting physician