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Lori, 55, is an overweight diabetic who presents to the dermatologist with dozens of painful boils under her arms and groin draining foul-smelling pus.
His body is covered with deep scars. She is embarrassed trying to date because she is aware of all the scars on her body.
As a result, she became more depressed and started smoking a pack of cigarettes a day. It affected his quality of life and emotional well-being by suffering from anxiety.
Recently she went to the dermatologist and was diagnosed with an inflammatory skin condition called hidradenitis suppurativa (HS).
To make matters worse, she discovered that it is a chronic condition that can be exacerbated by smoking.
Susan’s previous three columns:
Know your skin:Don’t ignore strange spots on your skin; it could be fatal melanoma
It can happen to anyone:Child abuse can occur across all socio-economic groups and races
Make your skin sing:Want your skin to look great this spring? Here’s what you should do
No one knows the exact cause of hidradenitis suppurativa, but experts believe it develops when hair follicles become blocked.
It is important to know that hidradenitis suppurativa is not caused by impurity and cannot be transmitted to others.
Hidradenitis suppurativa can be localized or generalized throughout the body, especially the armpits, breasts, and groin.
Signs and symptoms of the disease include:
- Small painful lumps the size of a pea.
- Leaky bumps.
- Tunnels or blackheads.
Some risk factors that may increase your chances of developing hidradenitis suppurativa include:
- Age. Increased risk for people in their 20s and 30s.
- Sex. Females are more likely to develop than males.
- Race. In the United States, the HS is significantly higher among African Americans.
- Family history. Can be inherited.
- Certain medical conditions increase the risk such as diabetes, obesity, severe acne, arthritis and inflammatory bowel disease.
The key to effective treatment is getting an early diagnosis of hidradenitis suppurativa. See your dermatologist if your condition:
- Becomes painful.
- Having difficulty moving.
- Does not improve within a few weeks with antibiotics.
- Reappears within weeks of stopping treatment.
Persistent and severe hidradenitis suppurativa can lead to complications, including:
- Infection. The presence of pus is common and does not necessarily mean an infection.
- Scars and skin changes that may look like strings or pitting.
- Restricted movement. Limited or painful movements, especially when affecting the armpits or thighs.
- Skin cancer. Squamous cell carcinoma has been reported with long-term hidradenitis suppurativa, with involvement of the perianal region.
- Swelling of the arms, legs or genitals. Many of the most common sites of HS contain many lymph nodes. Scar tissue can block the lymphatic drainage system, which can lead to swelling in the arms, legs, or genitals.
- Psychological effects and social isolation.
Treatment options may vary depending on the severity of the lesions. For less severe cases, a topical antibiotic can be an effective treatment.
Other ways to improve episodes are by switching to a healthy diet, losing weight, and quitting smoking.
Oral antibiotics such as Doxycycline or Bactrim can be used to treat more moderate to severe HS over a few weeks to a longer term, such as a few months.
Corticosteroids can be prescribed in pill form or given by injection to help reduce pain and swelling.
Biologics like Humira are very effective and can help put HS into remission. Some patients hesitate to take this treatment because they are afraid of the injections or fear that the immune system response will be lowered.
As a last resort, the dermatologist may refer to a general surgeon for tract excision, drainage or stripping.
Whatever treatment you choose, don’t hesitate to make an appointment with your dermatologist.
Be sure to bring a friend or family member to help you learn more about the condition and understand the benefits and possible side effects of different treatment options.
Be proactive and get treatment early before the skin condition spirals out of control and causes further physical and emotional scarring.
Susan Hammerling-Hodgers, a member of the National Psoriasis Foundation, is a PA-C (Certified Physician Assistant) and MPAS (Master of Physician Assistant Studies) and works at Brevard Skin and Cancer in offices in Merritt Island, Titusville and Rockledge.