Question: I’m nearly 24 and since about the age of 12, I have suffered with boils on my inner legs and under my armpit, sometimes even on my bikini line.
I have gone to my doctor and they have given me antibiotics and creams but nothing seems to help. They leave purple scars too. Is there anything I can do to help or get rid of these?
It’s such a nightmare. They really do put my self-esteem down.
Hi! My heart goes out to you. To me it very much sound like a condition called Hidradenitis Suppurotiva but I have not examined you.
This is a condition characterised by recurrent boils and abscess formation in the skin of arm pits / groin, under the breasts and pubic region (areas where we have what are called Apocrine Glands in our skin that is the sweaty areas), it is not however due to disease of the sweat glands as the name implies. Typically there are lots of scars from old cysts and sinuses or tracts between the lesions, which are pus filled. It is also known as Acne Inversa
Who gets it?
- Hidradenitis usually starts at puberty, and is most active between the ages of 20 and 40 years, and in women, can resolve at menopause. It is 3 times more common in females than in males.
- Other family members with hidradenitis suppurativa
- Obesity and insulin resistance/metabolic syndrome
- Cigarette smoking
- Follicular occlusion disorders: acne conglobata, dissecting cellulitis, pilonidal sinus
- Inflammatory bowel disease (Crohn disease)
- Rare autoinflammatory syndromes associated with abnormalities of PSTPIP1 gene
What causes it?
Hidradenitis suppurativa is an autoinflammatory disorder. Although the exact cause is not yet understood, contributing factors include:
- Friction from clothing and body folds
- Aberrant immune response to commensal bacteria
- Follicular occlusion
- Release of pro-inflammatory cytokines
- Inflammation causing rupture of the follicular wall and destroying apocrine glands and ducts
- Secondary bacterial infection
What is the treatment for hidradenitis suppurativa?
- General measures
- Weight loss; follow low-glycaemic, low-dairy diet
- Smoking cessation: this can lead to improvement within a few months
- Loose fitting clothing
- Daily unfragranced antiperspirants
- If prone to secondary infection, wash with antiseptics or take bleach baths
- Apply hydrogen peroxide solution or medical grade honey to reduce mal-odor
- Apply simple dressings to draining sinuses
- Analgesics, such as paracetamol, for pain control.
Medical management of hidradenitis suppurativa
Medical management of hidradenitis suppurativa is difficult. Treatment is required long term. I usually start with antibiotics and a contraceptive pill and can go from there to injecting the pustules all the way to removing the diseased skin. There are multiple ways to treat this depending on the patient, but we have no cure at the moment unfortunately, other than complete excision of the diseased skin, which can be very challenging, even then it is not a guarantee.
I hope this information helps you and remember you are not on your own, I have seen hundreds of patient’s with this condition and many have gone on to live normal healthy lives.
As you can see, I have included some very mild pictures, I have lots more that are way, way more awful looking, but these are at the very mild end of the spectrum as I don’t want to shock or upset anybody either.
I hope you find your answer and the best of luck
Dr. Mukesh Lalloo FRCS(Ed) MICGP
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