Purulent hydradenitis: what is it, causes, symptoms, treatment, prognosis

What is purulent hydradenitis?

Purulent hydradenitis (also called Verney disease, Velp diseaseO) Is a chronic condition characterized by swollen, painful lesions that occur in the armpits (armpits), groin, anal region, and breast. Verney disease occurs due to obstruction of hair follicles and secondary infection and sometimes inflammation of certain sweat glands (apocrine glands).

Suppurative hydradenitis, a progressive disease in which single, purulent abscesses become hard lumps, then painful, deep-set, often inflamed clusters of lesions with chronic leakage. Healing of the affected area usually occurs with progressive scarring (fibrosis) of the tissue.

In a severe course of the disease, chronic epithelial, sometimes interconnected, sinus pathways are formed. This often leads to sweat and bacteria entering the surrounding tissue, causing new inflammation and infection. Suppurative hydradenitis can be extremely painful and debilitating, but rarely life-threatening; disease occurs only when the bacterium leads to an overwhelming systemic infection in an immunocompromised person.

Suppurative hydradenitis was thought to be a rare disease because only the most severe cases were reported. Suppurative hydradenitis was first described in the medical literature by Dr. Velpeau in 1839 and was considered an extremely severe form of acne (inverse acne). It most often occurs during puberty because changes in hair follicles are triggered by a surge in sex hormones. The condition can also begin to occur in patients of any age after puberty, but rarely before. Cases vary in severity, but they all require some attention and treatment. Home remedies are sufficient for mild cases. However, for severe cases, daily medications are often prescribed and radical surgery may ultimately be recommended. Early diagnosis and treatment of Velpo disease is important because it can help manage symptoms and prevent new boils and lesions from forming.

Signs and symptoms

Suppurative hydradenitis is a chronic inflammatory disease that affects the sweat glands known as the apocrine glands. In most people with the disease, recurrent lesions develop in the armpit, groin, vulva, or anal area. However, in some cases, the condition can affect the sweat glands of the breasts, scalp, or other areas. Evidence suggests that the underarm or vulva area is more commonly affected in women, while the anal area is predominantly affected in men.

Although the age of onset can vary, symptoms often become apparent during puberty or early adulthood. The disease lasts for many years, with periodic improvement and worsening of symptoms. Many things can cause flare-ups of this condition, including menstruation in women, weight gain, stress, hormonal changes, fever, and sweating. In some cases, early symptoms such as itching or discomfort may precede the characteristic manifestations of the disease.

There are 3 clinical stages of the disease. Each stage is best treated with a variety of therapies. Ideally, treatment should stop the progression to stage 3 for as long as possible. However, purulent hydradenitis is not cured, and the disease will eventually take its course.

• Stage 1: In some cases, early symptoms, such as pruritus or discomfort, may precede the characteristic manifestations of the condition. photo below).
• Stage 2: Abscesses are periodically formed, with the formation of sinus tracts and scars. One or more widely separated lesions may be present.
• Stage 3: Diffuse or nearly diffuse involvement or multiple interconnected areas and abscesses are observed throughout the affected area.

Obstruction (occlusion) of hair follicles and rupture of the follicle leads to the development of tender or painful, reddish nodules and purulent cavities of infection (abscesses). Abscesses can spontaneously rupture, drawing out pus, which can mix with a clear liquid (serous-purulent), which often has an unpleasant odor. During healing, scar tissue and new lesions can form near the initial nodes. In some severe cases, deep abscesses can drain through abnormal channels deep in the skin tissues that connect them to the surface of the body (sinus tract formation). Re-healing and relapses lead to progressive scarring of the affected tissue, which may appear as thick, connected streaks. In extremely severe cases, the condition can become extensive and potentially disabling.

Causes and risk factors

The exact underlying cause of purulent hydradenitis is unknown, but the condition is likely the result of a combination of genetic and environmental factors.

Symptoms result from abnormal obstruction (occlusion) of the hair follicles and secondary bacterial infection and inflammation, followed by rupture of ducts, spread of infection and scarring. Another possible cause is pathological development of the glands.

Some patients have a family history of the disease, suggesting that genetic factors may play a causal role. In familial cases, the molecular complex of gamma-secretase has been implicated.

Affected populations

Velpo disease affects women about three times more often than men. About 1/100 of people suffer from mild cases of the disease. The condition usually becomes evident around puberty, but almost never after 40 years.

Symptomatic disorders

Symptoms of the following disorders may be similar to those of purulent hydradenitis. Comparisons can be useful for differential diagnosis:

• Furunculosis characterized by the development of inflammatory nodules known as boils or carbuncles due to infection with the staphylococcus bacteria. Boils are red, tender, or painful lumps that secrete the central tissue nucleus and pus. They can sometimes be repeated. Contributing factors that make a person vulnerable to furunculosis may include obesity, diabetes and poor hygiene.
• Tuberculosis skin - an infectious disease caused by the bacteria Mycobacterium tuberculosis (Koch's bacillus).
• Crohn's disease - inflammatory bowel disease, which rarely can have cutaneous manifestations that mimic the symptoms of purulent hydradenitis.

There are a number of other diseases that can have symptoms similar to those associated with Velpo's disease.

Diagnostics

Hidradenitis suppurativa often goes undiagnosed for years because patients are too embarrassed to talk to anyone about their symptoms. Diagnosis is based on symptoms, medical history, examination, and blood tests. If pus or fluid removal is present, a sample of the fluid can be sent for culture analysis to rule out other skin conditions.

- Clinical examination.

Ultrasonography of hair follicles and skin thickness can reveal abnormalities and show how the disease is progressing. Other tests that are used in assessing the stage of the disease are analysis C-reactive protein, general urine analysis, assessment of the level of IL-2 receptors in blood serum, assessment erythrocyte sedimentation rate, as well as a complete blood count with platelet count.

Standard treatments

There is no specific method for treating purulent hydradenitis. Treatment depends on what clinical stage the patient is in and on the severity of his condition. Also, what works for one patient may not work for another. Mild cases of the disease can usually be treated with home remedies, such as:

• the use of warm compresses;
• good hygiene;
• using antibacterial soap;
• the use of antiseptics and anti-inflammatory drugs;
• wearing loose clothing.

It is also important for patients with the disease to maintain a healthy weight and not smoke. Overweight people experience more friction on their body, which irritates the skin. They are also more prone to excessive sweating. Both help in irritating the skin, causing an outbreak of purulent hydradenitis.

Many patients with the disorder have difficulty maintaining their weight properly because physical activity causes them pain. Staying healthy is very important in slowing the progression of the disease, so every effort must be made to find the strength to exercise. Many patients report that swimming is not only great for keeping fit, but also provides temporary relief from painful lesions.

Moderate to severe cases of purulent hydradenitis may require medication. Possible medications include:

• antibiotics;
• oral retinoid medications;
• anti-inflammatory drugs;
• corticosteroids;
• hormones and inhibitors of alpha tumor necrosis factor.

Other treatments that have been shown to provide some benefit include:

• carbon dioxide laser therapy;
• laser hair removal;
• radiation therapy;
• surgical intervention.

In 2015, Humira (adalimumab) was approved for the treatment of purulent to moderate hydradenitis. It is the first and only FDA-approved drug for the treatment of adults with purulent hydradenitis.

Surgical removal of the lesions and skin grafting of the affected areas may be necessary in cases of extensive, permanent scar tissue. This operation is extensive as it is necessary to remove not only the skin containing the lesions, but also the wide margins around the affected area. Surgery has long been considered a cure for the disease, but specific studies have shown otherwise. Ideally, the disease will disappear in the areas where the skin has been transplanted; however, repeatability values ​​can be high, especially if only narrow fields are taken. More limited surgery, consisting of opening abscesses and sinus tracts, may be helpful in relieving symptoms, but these lesions almost always recur.

Forecast

Purulent hydradenitis is a chronic disease, i.e. it does not go away by itself. Despite ongoing treatment, the abscesses usually keep coming back. The disease, as a rule, gradually progresses, abscesses appear more often, in greater numbers and affect more areas of the body. The pathology is not life threatening, but people with the disorder may experience frequent pain, difficulty moving, and feel embarrassed or ashamed about their illness. It can cause social isolation. depression and / or anxiety and affect a person's quality of life.