Definition

Hidradenitis suppurativa, also known as multiple sweat gland abscesses, is a chronic skin disease characterized by the formation of small blisters, abscesses, and scars. This condition typically occurs in areas of the skin rich in sweat glands, such as the groin, anal region, breasts, and armpits. It is also referred to as acne inversa.

Causes

Multiple sweat gland abscesses occur when hair follicles, where hair grows, become blocked. However, the exact cause of this blockage remains unclear. It is believed to be associated with factors such as hormones, genetics, smoking, or excess body weight. Importantly, this condition is not caused by infection, poor hygiene, and is not contagious.

These hair follicles are located near the sweat glands. When blocked, the hair follicles can rupture, releasing their contents, such as keratin and bacteria, into the surrounding skin layer (dermis). This triggers an inflammatory response by the body's white blood cells, leading to the formation of abscesses, which cause pus accumulation.

Risk factor

Several factors increase the risk of developing multiple sweat gland abscesses:

• Age, this condition commonly occurs after puberty, particularly in individuals in their 20s and 30s.
• Female genders are more likely to develop hidradenitis suppurativa than men.
• Black ethnicity have a higher likelihood of experiencing this condition compared to white people.
• Family history of hidradenitis suppurativa increases the risk of developing the condition.
• Certain conditions:
• Obesity
• Severe acne
• Joint inflammation
• Diabetes
• Metabolic syndrome (a cluster of conditions related to blood sugar, cholesterol, high blood pressure, and obesity)
• Inflammatory bowel disease (IBD)
• Smokers are at a higher risk of developing sweat gland abscesses.

Symptoms

Multiple sweat gland abscesses usually affect both sides of the body (e.g., both armpits, both breasts). Several lumps can appear simultaneously, and the skin symptoms that may arise include:

• Black spots, often found in areas of indented skin, usually in pairs.
• Painful pea-sized lumps
• The condition typically starts with a single painful lump under the skin that persists for several weeks or months.
• These lumps can multiply, and usually develop in areas with many sweat and oil glands, or where skin rubs against skin, such as the armpits, groin, anal region, and breasts.
• Ruptured lumps or wounds, lumps and wounds can enlarge, burst, and release foul-smelling pus.
• Tunnels under the skin can form beneath the skin, connecting the lumps. These tunnels take a long time to heal and may drain blood or pus.

Symptoms can vary among individuals, with some experiencing mild symptoms and others facing severe symptoms. More severe symptoms are often associated with excess weight and smoking, although even thin and non-smoking individuals can experience severe symptoms. Severe symptoms may include multiple lumps, extensive scarring, and prolonged pain, which can make it difficult to move the affected body part.

Diagnosis

Diagnosing multiple sweat gland abscesses typically does not require special tests. Doctors can usually make the diagnosis based on the patient's medical history, including when the lumps appeared, the level of pain, any previous similar symptoms, and whether there is a family history of similar conditions. If pus is present, a sample may be taken for laboratory examination to identify the type of bacteria present, though this condition is usually not associated with bacteria that cause skin infections.

The severity of the abscesses can also be assessed during the examination. Determining the severity is crucial for deciding on the appropriate therapy.

Management

Multiple sweat gland abscesses (hidradenitis suppurativa) can be a recurrent and challenging condition to manage. Early treatment at a mild stage is crucial, as it can often be controlled with medication. However, more severe cases may require surgical intervention. The following are common treatment options:

1.  Warm Compress:

• For mild cases, applying a warm compress can help alleviate discomfort. Soak a clean handkerchief in warm water and place it on the affected area for 10 minutes.

2.  Painkillers:

• Over-the-counter painkillers like ibuprofen can help reduce pain and swelling associated with abscesses.

3. Antibiotics:

• Antibiotics may be prescribed to combat bacterial infections, as blocked hair follicles can lead to bacterial overgrowth, causing infection and pus formation. Antibiotics can be administered orally or topically, depending on the severity.

4. Other Medications:

• Anti-inflammatory medications, such as corticosteroids, can be injected directly into the lumps to reduce inflammation, pain, and swelling. In severe cases, oral medications may be prescribed. Retinoids, which are typically used in severe cases, can also be an option for treatment.

5. Surgery:

• If the abscesses extend into deeper layers of the skin, surgical intervention may be necessary. This can involve draining the pus or repairing the damaged skin. Skin grafts may be used during the procedure. Laser therapy is another option that may be considered by the doctor.

In addition to medical treatment, certain lifestyle changes can help manage symptoms:

• Losing weight can reduce skin friction, which may alleviate symptoms.
• Smoking cessation can improve symptoms, and a smoking cessation program can be discussed with your doctor.
• Do not shave the affected area, as it can worsen irritation.
• Wear loose clothing, because tight clothing can increase skin friction and exacerbate symptoms.
• Keep body temperature cool, since excessive sweating can worsen symptoms, but be cautious with deodorant use, as it may irritate the skin.
• Keep the affected area clean, using your fingers rather than cloths, which can cause irritation. Antibacterial soap may help reduce odors.

If a lump is leaking, cover it with a non-stick plaster. Applying petroleum jelly to the plaster can help avoid pain associated with removing sticky plasters.

Complications

Complications of multiple sweat gland abscesses may include:

• The affected area is highly prone to infection, although the presence of pus does not necessarily indicate an infection.
• The wounds that have healed may leave rope-like scars or cause the skin to dip inward.
• Scars and painful wounds, particularly in the armpit or groin, can restrict movement.
• Long-term multiple sweat gland abscesses are associated with an increased risk of skin cancer, such as squamous cell carcinoma.
• Scar tissue near lymph nodes can obstruct lymph flow, causing swelling.
• The location, odor, and flow of pus discharge can lead to embarrassment, social withdrawal, anxiety, or depression.

Prevention

While it is challenging to prevent multiple sweat gland abscesses entirely, the progression of the disease can be slowed with medication and lifestyle improvements as outlined in the management section.

When to see a Doctor?

Early diagnosis of multiple sweat gland abscesses is crucial for effective treatment. You should seek medical attention immediately if you experience persistent pain, moving difficulty, the symptoms do not improve after treatments, the symptoms are flaring-up after they have subsided previously, multiple areas of the body are affected simultaneously, and the symptoms frequently occur. Multiple sweat gland abscesses are not just simple blisters that disappear in a few days; they are a complex health condition that often requires a multidisciplinary approach for proper management.

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