Pain
Flare, Burning
Itching
Hyperhidros
Hidradenitis suppurativa is a long-lasting skin disease with small, painful tubers under the skin. They are usually characterized by inflammatory currents that are just below the skin. It mostly develops in body parts such as underarms, groin and breasts.
The tubers can also move in the form of tunnels beneath the skin as they are exposed to the outside.
Hidradenitis suppurativa begins after puberty. It can continue for many years and may worsen over time. It can have serious effects on your daily life and emotional state. Early diagnosis and treatment helps manage symptoms; Prevents complications such as new tubers, scarring or depression.
Hidradenitis suppurativa commonly occurs around the hair follicles with the fat and sweat glands in the underarms, groin and anal regions. At the same time, it can be seen between the legs, breasts and thighs, where the skin rubs against each other. Hidradenitis suppurativa can affect a point or multiple areas of the body.
Hidradenitis suppurativa can usually be seen as a single, painful lump that starts between puberty and age 40. For some people, the disease gets worse and affects many areas of the body. In some cases, only mild symptoms persist. Excessive weight, stress, hormonal changes, heat or moisture can aggravate the symptoms. In women, the severity of the disease may decrease after menopause.
Hidradenitis suppurativa develops when hair follicles become blocked and inflamed. The exact cause of this blockage is not known. Possible causes include hormones, metabolic syndrome, genetic factors, irregular immune response, smoking and excessive weight.
Hydradenitis suppurativa is not caused by an infection. It's not sexually transmitted. It is not an infectious disease.
There are different treatments for hydradenitis suppurativa. Early diagnosis and long-term treatment; It helps to control the pain, supports the healing of the wounds, prevents the formation of new tubers and can prevent complications.
Various treatment options are available. Once you have your doctor examination, you must decide together.
Your doctor may prescribe one or more of the following types of medicine:
Topical and oral medications: These include medicines that contain antibiotics and vitamin A (retinoid).
Other drugs that reduce inflammation: Injecting steroids directly into the nodule can reduce inflammation.
Hormones: Small studies comparing oral antibiotics with hormonal therapy have shown that hormone therapy is as effective as antibiotic in the treatment of hydradenitis suppurativa wounds. Hormonal therapy is not suitable for pregnant women due to the risk of side effects.
Hidradenitis suppurativa can be treated with various surgical procedures. The method used depends on the scope and location of the wounds as well as other factors.
Uncovering the tunnels: This procedure, known as digestion, is favored on the incision and drainage. Your doctor removes skin and subcutaneous tissue covering the tunnels connected to each other. This solution usually does not have to be repeated.
Fist debridement: This procedure is also called mini-unroofing and can be used to remove a single inflammatory nodule.
Incision and drainage: Surgical drainage can be an option when the disease affects a single small area. This treatment usually provides short-term pain relief, but the wounds tend to recur.
Tissue protective excision with electrosurgery: This can be an option for people with severe hidradenitis suppurativa. It combines skin-tissue excision with electrosurgical peeling (STEEP). The goal is to remove diseased tissue and maintain healthy tissue. General anesthesia is applied for the STEEP procedure.
Surgical removal: Surgical treatment of recurrent or severe symptoms involves removal of all involved skin. A skin patch may be needed to close the wound. Even after surgery, wounds may occur in other areas.
As a result, the removal of that region and the new tissue transplantation to that region is the most effective treatment today and is successfully applied.
Pain
Flare, Burning
Itching
Hyperhidros
Factors that may increase your risk of developing the disease:
Persistent and severe hydradenitis suppurativa often causes complications:
Infection: Infections may occur in the affected area.
Wounds and skin changes: The wounds may heal, but leave rope-like scars, pitted skin, or darker skin spots than usual.
Restricted movement: Wounds and scar tissue can cause a limited or painful movement, especially when it affects the patient's underarms or thighs.
Clogged lymph drainage: There are many lymph nodes where hidradenitis suppurativa is seen. Scar tissue may interfere with the lymphatic drainage system, which may result in swelling of the arms, limbs or genitals.
Social isolation: location, drainage and smell of wounds; embarrassment, reluctance to communicate with people, may cause sadness or depression.
Cancer: Rarely, patients with enhanced hidradenitis suppurativa may develop squamous cell carcinoma of the affected skin.
Mild hydradenitis suppurativa can only be treated with self-care measures. Personal care is an important complement to any medical treatment. The following recommendations can help improve the speed of discomfort and wounds:
Do not disrupt your daily skin care: Gently wash your body with a nonsoap cleaner such as Cetaphil. Do not use your hands, pouches, fibers or other products that may irritate the skin. If a bad smell is present, try washing your body with antibacterial soap. The application of an additional absorbent powder or zinc oxide may also be helpful. Using antiperspirants can help keep the skin dry. Stop using any product that irritates your skin.
Manage your pain: Gently applying a wet or warm cloth can help reduce swelling and alleviate pain. Continue for approximately 10 minutes. Ask your doctor to recommend the most appropriate pain killer. And talk to your doctor about how to properly care for your wounds at home.
Avoid tight clothing and irritating products: Wear loose, light clothing to reduce friction. Some women prefer this method because they think that using tampons rather than hygienic pads creates less friction with the skin. Use detergents and other products that do not contain perfume, dye or enzymes.
Avoid injuring skin: For example, do not squeeze acne and wounds. Do not shave the affected skin.
Lose weight and stay active: not having healthy weight can make symptoms worse. Try to find activities that do not irritate your skin.
Consider changing your diet: Try to avoid dairy products, processed sugar, flour, beer and other foods containing yeast or wheat.
Avoid all tobacco products: Smoking and other tobacco use may lead to worsening of hydradenitis suppurativa.
Daily zinc supplements can help reduce inflammation and prevent new outbreaks.
Hidradenitis Suppurativa is an inflammatory disease characterized by the accumulation and subsequent inflammation of the sweat gland as a result of the obstruction of the channels opening to the skin of the sweat glands, including the hair follicle.
The inflammation in this formed sweat gland then opens tunnels and spreads to other sweat glands and other tissues under the skin. Since it is an inflammatory disease, inflammatory and anti-inflammatory drugs have an effect in its treatment. These are anti-inflammatory drugs as well as antibiotics. In addition, some immunomodulatory drugs, which we call TNF-Alfa biokers, have also shown their effects in this disease.
However, an initiated Hidradenitis Suppurativa disease can never be cured completely with drugs. Because the inflammation does not completely disappear there. Healed areas heal with hydrosis, and an infection that started in areas with sweat glands and hair follicles can recur at short or long intervals. Here, real and complete treatment is only possible with surgery.
There are several forms of the surgical method: One of them is the methods that will drain the inflammation and relax the patient. With these -minor surgical procedures- inflammation is eliminated in the active period. But the definitive treatment is based on the method of completely removing the diseased area in that region and covering those areas with skin patches. When this entire inflammatory area is removed, the chance of recurrence of the disease in that area is zero. However, where there are sweat glands in other parts of the body, there is still a chance for the disease to arise. The thing to do here is to excise that area with minor surgical interventions as soon as the disease starts, so that people can return to their normal life.
As a result, there is a complete cure for Hidradenitis Suppurativa. The method for this is only surgery.
The exact cause of hidradenitis suppurativa is not known yet. However, genetic factors are one of the most important factors of this disease. In addition, hormones, excessive weight, alcohol and cigarette consumption are known to trigger hidradenitis supurativity.
Hidradenitis suppurativa is frequently seen in the areas such as armpit, underarm, groin, belly button circumference, hips, inner legs and female genitals.
In the cases of early diagnosed hidradenitis suppurativa, progression of the disease can be prevented by drug treatment. However, the region's surgical removal is the most effective treatment.
Hidradenitis suppurativa is characterized by small and flowing tubers that initially penetrate beneath the skin in the regions where it is seen. These chronic wounds can progress in the form of tunnels under the skin with time, and can also be seen in the surface of the skin as itching and itchy wounds.
Hidradenitis suppurativa disease can be done in a single session by looking at the patient's condition and the size and depth of the wound, it can also take a few sessions.
As with any surgical operation, the degree of difficulty may increase or decrease depending on the person's body resistance, the size of the wound and the distribution area. Your doctor will share the most accurate information on this subject with your previous examinations.
Hidradenitis suppurativa begins after puberty. It can continue for many years and may worsen over time. The treatment of this disease with medications is not a definitive solution. Although it extinguishes for the moment, the time may also flare again. The definitive solution is surgery. If the surgery is well planned and taken broadly, it is not expected to be seen again in the received areas.
Hidradenitis suppurativa usually takes 2-3 hours depending on the width of the wound site and the area under general anesthesia.
Although HS is not an infectious disease, it can impair the quality of life of people living with this disease because it is intervined too late.
As in all surgical operations, the state of pain varies depending on the person's body. In addition, the width of the region to be operated, the areas to be interfered with also affect the pain status. However, the pain can be controlled in the hospital environment. Then you can easily overcome this period with your doctor's recommended painkillers.
Each surgical operation carries a certain risk. These risks vary according to the technique, the general condition of the patient, the size of the disease, the size of the intervention and many other reasons. In addition to this, bleeding, infection, repetition of the region due to inability to be taken out well and the risks arising from anesthesia are present.
As with any surgical operation after surgery, the recommendations of the doctor must be strictly adhered to in order to prevent the risks such as infection, bleeding and so on. In addition, very heavy exercises should be avoided during the first few weeks after the operation.
After all surgical operations, a trace remains due to the width of the surgical site. However, these traces lose considerable visibility over time. In Hidradenitis operations, there is a certain amount of trace in the regions where surgery is performed.
The most common symptom is the small pit areas with black spots. Except this; red, sensitive tubers, painful pea-sized tubers are symptoms of hidradenitis suppurativa. These are the growing and inflamed tubers that can last for many years under the skin.
Playing sports does not directly worsen hidradenitis suppurativa (HS), but in some cases it can trigger symptoms. Excessive sweating, friction and heating of the skin, especially during intense exercise, can cause HS lesions to enlarge or new lesions to form. However, regular and appropriate light exercise can have positive effects on overall health and help manage the disease by reducing stress. Therefore, precautions can be taken when exercising, such as avoiding prolonged accumulation of sweat on the body, wearing comfortable clothing and keeping the skin clean after exercise.
Although complete prevention of Hidradenitis Suppurativa (HS) is not possible, there are some preventive measures that can help to avoid a flare-up of the disease. Firstly, comfortable, cotton clothing should be worn to reduce excessive sweating and skin friction. Regular skin cleansing and hygiene can reduce the risk of bacterial infection. However, smoking can also increase the severity of HS, so smoking cessation is recommended. Eating a healthy diet, especially low glycemic index foods, can alleviate the symptoms of the disease. It is also important to employ stress management techniques as stress can lead to exacerbation of HS.
Hidradenitis Suppurativa (HS) can sometimes be confused with other skin conditions because there are many skin conditions with similar symptoms. In particular, it can be confused with acne (acne), folliculitis, abscess formations or skin problems caused by infected sweat glands. Although HS is characterized by inflammation and painful lesions, especially under the skin, these symptoms can also occur with some infections or other inflammatory skin diseases. In addition, the scars and scarring left on the skin by HS can be confused with the effects of other skin conditions. Therefore, a thorough evaluation by a dermatologist is important to make an accurate diagnosis.
Hidradenitis Suppurativa (HS) is usually a chronic skin disease and can be difficult to fully recover from. Treatment focuses on relieving symptoms and stopping the progression of the disease. However, depending on the course of the disease, some individuals may go into long-term remission (disappearance of symptoms) with treatment, while others may experience persistent flare-ups. With early diagnosis and appropriate treatment, quality of life can be significantly improved, but a complete cure is usually not possible. Treatment options include topical treatments, antibiotics, biologics and surgery.
Hidradenitis Suppurativa (HS) is a skin disease usually characterized by inflamed, painful abscesses on the skin. The stages of this disease are usually classified by the Hurley staging system.
The first stage (Hurley stage I) is limited to abscesses or nodules alone, but usually in a single area.
The second stage (Hurley stage II) is characterized by the formation of multiple abscesses and sinuses (canals), affecting larger areas.
The third stage (Hurley stage III) is a widespread and severe stage in which these sinuses merge with each other and cause large lesions. This staging helps to determine the severity of the disease and the need for treatment.
To distinguish between Hidradenitis Suppurativa (HS), also known as dog teat disease, and boils, it is important to note some important differences. A boil is a painful, red, pus-filled swelling that usually occurs in a single area, is caused by a bacterial infection and can heal quickly with treatment. Hidradenitis Suppurativa, on the other hand, is a recurrent skin disease that occurs bilaterally and chronically in fold areas such as the armpits and groin. In HS, multiple lesions, fistulas and scars can form close to each other over time, while the boil can usually heal as a single and scarless lesion. If the lesions recur frequently, appear in more than one place and persist for a long time, these symptoms may indicate Hidradenitis Suppurativa.
People with Hidradenitis Suppurativa (HS) can generally swim in the sea or pool, but in some cases caution is needed. Getting into the water can increase the risk of infection, especially if there is an active wound, open lesion or inflamed area. Chlorinated pool water can also irritate the skin of some people. Sea water, on the other hand, can help dry and soothe wounds in some patients. Nevertheless, the skin should always be cleaned and kept dry after entering the water. In any case, it is safest to act in consultation with a doctor.
Hidradenitis Suppurativa (HS) is not transmitted during childbirth or through breastfeeding as it is not a contagious disease. The disease may be associated with a genetic predisposition, meaning that individuals with a family history of HS may be more likely to develop the disease, but this does not mean that the disease is passed directly from mother to child. There is also no milk-borne transmission of HS during breastfeeding, and if the mother's active lesions are in an area other than the breast, it does not interfere with breastfeeding. However, if there is a lesion in the breast and there is an open wound or infection, caution should be exercised during breastfeeding and the advice of a physician should be followed.
Although Hidradenitis Suppurativa (HS) is not classified as an autoimmune disease, it is considered a chronic inflammatory disease associated with the immune system. The exact cause of HS is unknown and is characterized by inflammation caused by the immune system overreacting to hair follicles under the skin. Furthermore, individuals with HS are more likely to be associated with autoimmune diseases (e.g. inflammatory bowel disease, spondylitis) than the general population. This suggests that HS may be associated with immune system dysregulation. However, HS is not considered to be a direct autoimmune disease, but rather closer to the group of autoinflammatory diseases.
Hidradenitis Suppurativa (HS) can also occur in children, but tends to occur after puberty. Because the development of HS is often associated with hormonal changes, the disease usually begins after puberty. However, rare cases of childhood onset have been reported. Genetic predisposition, obesity and early-onset hormonal changes may increase the risk of developing HS in childhood. Diagnosis in children can be more difficult because the disease can often be mistaken for acne, hair follicle inflammation or other skin problems. It is therefore important to consult a specialist, especially if painful skin lesions recur and do not heal.
After Hidradenitis Suppurativa surgery, temporary restriction of movement may occur, especially if the fold areas such as the armpit or groin area have been intervened. This is usually related to the wound healing process. After the surgical procedure, patients are advised not to strain the area too much in the first weeks in order to prevent stretching of the stitches and prevent wound opening. Especially in armpit surgeries, raising the arm upwards, and in groin surgeries, prolonged sitting or spreading the legs wide can be challenging. However, this limitation is usually temporary. With appropriate wound care, it returns to normal over time.
A certain level of pain can be expected after Hidradenitis Suppurativa surgery and is usually part of the normal healing process. The intensity of the pain may vary depending on the extent of the surgery and the area intervened. For example, pain may be more pronounced in cases where large areas are removed or skin grafting is applied. However, this pain is usually controlled with painkillers. The pain, which is more intense in the first few days, usually decreases after the 3rd day. Avoiding sudden or forceful movements that may cause pain and taking wound care as recommended by the doctor both accelerate the healing process and reduce the level of discomfort.
© Prof. Dr. Bekir Atik, MD. All Rights Reserved.
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