Lymphedema and Hidradenitis Suppurativa

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Lymphedema and Hidradenitis Suppurativa

Postby patoco » Sat Jun 10, 2006 2:27 am

Lymphedema and Hidradenitis Suppurativa

Our Home Page: Lymphedema People


For: Jim and Jude


Lymphedema and Hidradenitis Suppurativa

This is a chronis condition of the apocrine glands in the axillae, usually affecting women, also a large number of men. As the disease progresses, ulcers appears, sinus tracts can become enlarged, fistulas develop, and fibrosis and scarring can happen.

Also, because it is an infection, there can be serious damage to the lymphatics and infact lymphedema is a very real possible complication.


Hidrandenitis Suppurativa

Hidradenitis Suppurativa (HS) is an uncommon chronic inflammatory skin condition.

It effects inverse areas of the body, top of inner thighs, bottom, genitals, armpits, under the breasts in women and less commonly the stomach, hair line and behind the ears.

The symptoms of Hidradenitis Suppurativa vary greatly, it can be as slight as black heads and pimples or as serious as large draining lesions, growing to the size of golf balls.

It has been suggested that HS may not be as rare as believed, but that people are hesitant to come forward through shame and embarrassment. Also the figures are low through lack of accurate diagnosis.

Very little research has been done into Hidradenitis Suppurativa. It is known as an 'orphan' illness, which means, because it is considered rare there are no pharmaceutical companies that have taken up the challenge to find a decent treatment or cure. What we do know however, is that it is caused by the tendency of the appocrine hair follicle to become blocked.

The question now is why?

HS has been linked with auto immune disorders, it also has been found to have a genetic link. HS is more common in women, and seems to be effected by the hormones, although no exact pattern has emerged. As with many skin disorders, HS symptoms are increased by stress.

The three clinical stages of Hidradenitis Suppurativa :

Stage 1: Single or multiple abscesses form, without sinus tracts and cicatrization (scar formation)

Stage 2: Recurrent abscesses form, with tract formation and cicatrization. There may be single or multiple widely separated lesions.

Stage 3: Diffuse or near-diffuse involvement or multiple interconnected tracts and abscesses are observed across the entire area

It has been reported that as many as 80% of HS sufferers are diagnosed as clinically depressed. Depression is common amongst people who have to live in chronic pain. It can be treated with medication, but to cure the depression completely the reason for the depression must be removed. As there is no known cure for HS, this is not possible.

Diagnosis of Hidradenitis Suppurativa

If you have more than three boils in any one year, you should visit your Medical Practitioner.

Boils can be a symptom of many illnesses and your doctor should test you for these. The diagnosis of Hidradenitis Suppurativa generally comes from the dermatologist, and is made from observing the areas where the boil-like lesion are, and the common presence of black heads and scarring.

It is easily diagnosed if the dermatologist is familiar with the skin disorder.

Medical Treatments for Hidradenitis Suppurativa

There is not a single treatment that has been developed specifically for Hidradenitis. Therefore active involvement in choosing treatment and research is advisable. What may work for one patient, may be detrimental to another.

Although HS is not Acne, the symptoms are sometimes similar and Dermatologists are keen to suggest Acne treatments, which have been proved to be ill-effective.

Here is a list of the current treatments that may be offered to HS patients:

Antibiotics, (commonly tetracyclines) long term as a preventive measure, and short term (typically Ciprofloxicillin) for secondary infections. Many of these antibiotics react badly with sunlight and alcohol, and can cause nausea and bowel problems.

High-dose systemic steroids for their inflammatory effect.
Birth control Pills, as a measure to balance hormones.
Retinoids have been used with limited results.

Surgical treatments for Hidradenitis Suppurativa

Stage 1: May need incision and drainage
Stage 2: recurring lesions can be surgically removed along with any connecting tracts. Secondary healing is found to be most effective. There is a 50% chance of reoccurrence.
Stage 3: As the disease progresses, skin grafts and plastic surgery may be needed because of poor healing.

Radiotherapy is a treatment that is starting to be used again for HS.
A recent study by Frochlich et al in Germany reported complete relief in 38% of patients, 40% dramatically improved and 2% had no effect. There were no reported complications, associated with the radiation.

Recommended HS Sites

Support for sufferers of Hidraenitis Suppurative

David Stearns'

HS Petition

SkinCell supports the petition for increased research and improved treatment for sufferers of this condition.

If you would like to help in this worthy cause please Read our Petition Thread

Information from:

Skin Cell International Forum

Home Page:


Hidradenitis Suppurativa

Chronic, often debilitating skin disease

Imagine having a skin disease that your doctor did not understand, that was painful, that none of the treatments you tried made any better, and that kept getting worse over time rather. Some days you wouldn't go out in public because of the painful sores on your skin. You would then have some idea of what having hidradenitis suppurativa is like.


Hidradenitis suppurativa usually develops in otherwise healthy people, but it has been associated with Crohn's disease in some individuals. It is a non-contagious skin disease that usually appears on the body in skin folds of the underarms, groin, or perianal area. It has three main stages, beginning with boils or pockets of infection (abscesses). These become hard, painful, inflamed lumps with drainage (suppuration).

Tunnels (sinus tracts) may form around and between the lumps. Scars form. The last stage is the most debilitating, because large areas of skin are affected by the abscesses, sinus tracts, lumps, and scars.

Worsens over time

Hidradenitis suppurativa usually develops slowly over time, with flare-ups, but in some people the disease progresses quickly. The course of the disease varies for each person. Some will stay at one stage most of the time; others will develop debilitating disease.


There is as yet no definitive, consistently effective treatment, and no cure. Abscesses can be drained, and in severe cases the painful lumps and sinus tracts can be surgically removed. Radiation therapy has proved helpful for some people. Pain medications, and sometimes antibiotics, can also help.

A rare disorder?

Few studies have attempted to discover how prevalent hidradenitis suppurativa is in the world. One figure given is 1% of the general population is affected. It seems clear that the disease could be easily misdiagnosed as boils, carbuncles, or just a skin infection, so hidradenitis suppurativa may not be rare at all. More research needs to be to determine what causes the disease, how prevalent it is, and how it can best be treated and cured. ... /index.htm


Hidradenitis Suppurativa

Hidradenitis suppurativa is an uncommon disorder of unknown cause in which boil-like lumps develop in the groin and some times under the arms and under the breasts.

Treatment of hidradenitis suppurativa

This is difficult.

Wash with antiseptics or acne preparations to reduce skin carriage of commensal bacteria.

Take short course of antibiotics for acute abscesses (red, hot painful discharging lump) due to staphylococcal infection.

Flucloxacillin or dicloxacillin are the most suitable, except in the case of penicillin allergy.

Incision and drainage of abscesses - at the very painful pointing stage.

Take a prolonged course of tetracycline or metronidazole (minimum 3 months) for their anti-inflammatory action.

Three-month courses of the combination of clindamycin and rifampicin may be effective.

Persistent hidradenitis lumps may be excised after several months of conservative treatment (i.e. waiting and/or antibiotics).
Trial of the oral contraceptive pill for 12 months or more - usually Diane-35 or Estelle 35, which contain moderate oestrogen and cyproterone acetate.

Oral retinoids (vitamin A derivatives) for 6 to 12 months, especially isotretinoin, which are very effective for acne, may also help hidradenitis suppurativa.

Radical excisional surgery is reserved for very severe cases of hidradenitis suppurativa.


Hidradenitis Suppurative

Last Updated: September 9, 2004

Synonyms and related keywords: spiradenitis, apocrine glands, sweat glands

Author: Diana Fite, MD, FACEP, Clinical Assistant Professor, Department of Emergency Medicine, University of Texas Medical School at Houston, Hermann Hospital


Hidradenitis Support Group


Hidradenitis Suppurativa

Painful local inflammation of the apocrine glands resulting in obstruction and rupture of the ducts.

Usually S. aureus is initially involved, but gram-negative organisms such as Proteus may predominate in chronic cases.

Symptoms, Signs, and Diagnosis

The lesions may be confused with furuncles but tend to be more persistent and are diagnosed primarily by their location and clinical course. Clinically, the lesions are typically tender, reddish purple nodules resembling furuncles but occurring in apocrine sweat gland-bearing areas, including (in decreasing frequency) the axillae (see Plate 112-2-2), the groin (see Plate 112-2-3), around the nipples, and around the anus (see Plate 112-2-4). Pain, fluctuation, discharge, and sinus tract formation are characteristic among patients who have had the disorder for years. In other chronic cases, coalescence of inflamed nodules may cause palpable cordlike fibrotic bands in the axilla. The condition may become extensive and disabling; if the pubic and genital areas are involved, walking may be difficult, and odors may be unpleasant.

Although incisional biopsy can be diagnostic, the diagnosis is invariably made on clinical grounds. Bacterial cultures may be helpful.


Susceptible patients should avoid irritants such as antiperspirants. Early simple cases are treated with incision and drainage, moist heat, and prolonged systemic antibiotic therapy (see Furuncles, above). Intralesional corticosteroids may be effective in isolated lesions. Surgical excision and repair or grafting of the affected areas may be necessary if the disease persists. Isotretinoin 2 mg/kg/day po has been effective in some patients, but recurrences are common. Etretinate (0.7 to 1.5 mg/kg/day po) may also be effective, but recurrence is rapid on cessation of therapy. These drugs must be used with caution ... 2/112k.jsp


Organization in support of finding a cure
for Hidradenitis Suppurativa


Hidradenitis Suppurativa

Hidradenitis is a chronic disease of the apocrine glands (a form of sweat gland found on certain parts of the body). For unknown reasons, people with hidradenitis develop plugging or clogging of their apocrine glands. It causes chronic scarring and pus formation of the underarms (axilla) and groin/inner thigh areas. In women it can also occur under the breasts. It is similar to acne, which is also a disease of the sebaceous glands. Hidradenitis is more common in people who have had acne. It may be an unusual type of adult acne.

This condition is slightly more common in women and African-Americans. Hidradenitis usually starts as one or more red, tender, swellings in the groin or armpits. Over a period of hours to days the lesions enlarge and often open to the skin surface draining clear to yellow fluid. The involved area then heals with scarring. The condition usually continues for years with periods of flare and remission.

Bacterial infection produces the pain and odor. Hidradenitis is made worse by being overweight, however this condition is not caused by obesity and weight loss will improve but not cure hidradenitis. Hidradenitis may become worse under stress. Hidradenitis is not caused by poor hygiene.

Initial treatments are usually oral antibiotics (minocycline, tetracycline, erythromycin, Augmentin, others) and topical antibiotics (Cleocin-T, Emgel, others). Intralesional injections into the affected places reduce swelling and tenderness within days. Anti-inflammatory pills (Celebrex, Advil, Naprosyn, Alleve, and others) are helpful in addition to the antibiotics, especially if it is a severe case. Some women respond to high estrogen birth control pills (Demulen 1/50 Ortho Novum 1/50) and spironolactone pills.

Tight fitting clothing and shaving the areas are to be strictly avoided. Dirt does not cause hidradenitis. The involved areas should be cleaned daily using an antibacterial soap, as this will reduce any odor associated with this condition. Retin-A cream, a prescription, helps some people. Accutane, a drug for severe acne, offers modest help for moderately bad cases. There is medical control, but not cure for hidradenitis.

Surgery is the most effective treatment for hidradenitis. Aggressive surgery will cure an area of severe, chronic hidradenitis but it has to remove scarred tissue or even large areas of skin. Skin grafts may be needed. Incision (lancing) and draining will reliably help smaller affected areas. Because surgery scars and may have complications, medical treatments are usually tried first. ... suppu.html


Hidradenitis Suppurativa ... rativa.pdf


Hidradenitis Suppurativa


It is possible that the main title of the report Hidradenitis Suppurativa is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.


Hidradenitis Axillaris

Disorder Subdivisions


General Discussion

Hidradenitis suppurativa is a chronic, pus-producing (suppurative), scarring (cicatricial) disease process that occurs due to obstruction of hair follicles and secondary infection and inflammation of certain sweat glands (apocrine glands), particularly those under the arms (axillae) or within the anal/genital (anogenital) region. The disease is characterized by the development of recurrent, boil-like nodular lesions and deep pus-containing pockets of infection (abscesses) that may eventually rupture through the skin. Healing of affected areas is typically associated with progressive scarring (fibrosis). The specific underlying cause of hidradenitis suppurativa is unknown.


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For a Complete Report

This is an abstract of a report from the National Organization for Rare Disorders, Inc. ® (NORD). A copy of the complete report can be obtained for a small fee by visiting the NORD website. The complete report contains additional information including symptoms, causes, affected population, related disorders, standard and investigational treatments (if available), and references from medical literature. For a full-text version of this topic, see


Ruth's Hidradenitis Suppurative Links ... ativa.html

Reflex sympathetic dystrophy with hidradenitis suppurativa exacerbation: a case report.Moroz A, Lee MH, Clark J.Rusk Institute of Rehabilitation Medicine, Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY 10016, USA. alexmoroz@pol.netReflex sympathetic dystrophy (RSD) or complex regional pain syndrome type 1, is characterized by spontaneous pain or allodynia and hyperalgesia disproportionate to the inciting event, multiperipheral nerve involvement, edema, vasomotor or sudomotor change, and possible loss of function. It has been described in relation to various insults, including a number of infectious and inflammatory conditions. We report a case of a patient who developed RSD 1 week after an exacerbation of hidradenitis suppurativa, a rare chronic inflammatory disease of apocrine sweat glands. The patient responded well to a combination of range-of-motion exercises, thermal modalities, and oral steroids. Hidradenitis suppurativa should be considered when searching for an etiology of new onset RSD.

Publication Types: Case ReportsPMID: 11245766 [PubMed - indexed for MEDLINE] ... =iconabstr


Hidradenitis suppurativa: a review.

Wiseman MC.CancerCare Manitoba, Winnipeg, Manitoba, Canada.

Hidradenitis suppurativa is a recurrent disease involving apocrine-bearing skin with a predilection for intertriginous areas, including genital skin. It has a highly variable clinical course. Mild cases may present as recurrent isolated nodules, while severe instances of the disease with chronic inflammation may lead to scarring, functional impairment, and rarely, squamous cell carcinoma. While genetic factors, patient characteristics, hormones and infection play a role in disease expression, a comprehensive understanding of the pathogenesis remains to be elicited.

Additionally, effective treatment is largely unknown. While the mainstay of therapy had been surgery, and topical or systemic antimicrobial agents, other therapeutic modalities such as retinoids, hormonal therapy and immunosuppresive medications may also hold some promise.

Publication Types: Review Review, Tutorial PMID: 14756891 [PubMed - indexed for MEDLINE] ... =iconabstr


The pathogenesis of hidradenitis suppurativa: a closer look at apocrine and apoeccrine glands.

Attanoos RL, Appleton MA, Douglas-Jones AG.Department of Histopathology, University Hospital of Wales, Health Park, Cardiff, U.K.We undertook a retrospective pathological study of 118 skin resection specimens from 101 patients with hidradenitis suppurativa. Follicular occlusion was identified in all the specimens, regardless of disease duration (1 month to 18 years), but was not noted in the axillary and inguinal skin of controls.

We therefore regard follicular occlusion as an early and important feature in the pathogenesis of the disease. The presence of apoeccrine glands in axillary skin provided an in vivo model to directly observe the effects of follicular occlusion on follicle inflammation and apocrine gland destruction. In the majority of cases, active folliculitis was associated with apocrinitis and apocrine destruction, whereas apoeccrine glands, which drain directly on to the epidermal surface, appeared intact and non-inflamed. These observations provide direct evidence in an in vivo model that follicular occlusion by keratinous material, with subsequent active folliculitis and secondary destruction of the skin adnexae and subcutis, occur as an integral step in the pathogenesis of hidradenitis suppurativa.PMID: 7547393 [PubMed - indexed for MEDLINE] ... =iconabstr


Long-term results of wide surgical excision in 106 patients with hidradenitis suppurativa.

Rompel R, Petres J.Department of Dermatology, Klinikum Kassel, Kassel, Germany.

BACKGROUND: Hidradenitis suppurativa (acne inversa) is a chronic recurrent disorder characterized by abscessing inflammation, fistulating sinus tracts, and scarring. Predilection sites are the intertriginal regions. The severe course of the disease demands an early and curative treatment.

OBJECTIVE: The aim of this study was to review the effect of radical surgical excision concerning cure rate and potential complications within a large group of patients.

METHODS: We analyzed data for 106 patients suffering from hidradenitis suppurativa treated during the period 1980-1998. The mean duration of the disease was 7 years. In about 90% of the cases, two or more sites were affected. Inguinal (70.8%) and axillary regions (61.3%) were most commonly involved. All patients were treated by radical wide excision using intraoperative marking of sinus tracts with methylviolet solution.

The method of reconstruction depended on the size and location of the defect. Median postoperative follow-up time was 36 months.

RESULTS: The overall complication rate was 17.8%. Most of these were minor complications such as suture dehiscence, postoperative bleeding, and hematoma. Wound infection occurred in only 3.7% of patients. The rate of recurrence within the operated fields was 2.5%. There was no relation between the surgical method of reconstruction and the rate of recurrence. Recurrence was related to the severity of the disorder.

CONCLUSION: Our results confirm early radical excision as the treatment of choice for hidradenitis suppurativa. Using intraoperative color-marking of sinus tracts, the recurrence rate is minimal. The method of reconstruction has no influence on recurrence and should be chosen with respect to the size and location of the excised area.

PMID: 10886270 [PubMed - indexed for MEDLINE] ... =iconabstr


Histology of hidradenitis suppurativa.

Jemec GB, Hansen U.Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.

BACKGROUND: Hidradenitis suppurativa is traditionally classified as a disease of the apocrine gland. However, different histologic descriptions exist.

OBJECTIVE: Our purpose was to describe prospectively the histopathologic characteristics of hidradenitis.

METHODS: We systematically described and classified 60 consecutive biopsy specimens from patients with hidradenitis and compared them with 33 specimens from clinically noninvolved regional controls.

RESULTS: A heterogeneous histologic picture was found. Apocrine glands were involved in a minority of the 60 specimens, 17 showed poral occlusion, 17 simple folliculitis without poral occlusion, 9 sinus tracts, 6 epithelial cyst, 5 abscess, 3 apocrinitis, 2 diffuse dermal inflammation, and 1 pyogenic granuloma and scarring. Secondary involvement of apocrine glands was found in 12% of all specimens, and secondary involvement of eccrine glands was found in 25%. Sinus tracts were found significantly more often in the presence of poral occlusion or epithelial cysts. Control specimens frequently revealed changes compatible with early stages of follicular involvement. Apocrine glands were observed significantly more often in the axillae than in the groin.

CONCLUSION: The clinical picture of hidradenitis suppurativa covers a broad histologic spectrum. This may help explain the therapeutic problems posed by this disease. The disease appears to be predominantly follicular, and apocrine glands appear to be primarily involved in only a minority of axillary lesions.PMID: 8647993

[PubMed - indexed for MEDLINE] ... =iconabstr


Treatment of long-standing extensive perianal hidradenitis suppurativa using double rotation plasty, V-Y plasty and free grafts.

Liron-Ruiz R, Torralba-Martinez JA, Pellicer-Franco E, Morales-Cuenca G, Martin-Lorenzo JG, Miguel-Perello J, Aguayo-Albasini JL.Department of General Surgery 1, Hospital General Universitario JM Morales Meseguer, C/Marques de los Velez s/n, 30008, Murcia, Spain.

BACKGROUND: Perianal hidradenitis suppurativa is a chronic recurrent inflammatory, suppurating, and fistulizing disease of apocrine glands, adjacent anal canal skin, and soft tissues. The standard treatment used for extensive cases is a staged surgical procedure allowing the wound to heal by secondary intention or the delayed use of skin grafts.

CASE PRESENTATION: A long-standing case, disabling for the patient, with extensive involvement of the buttock region, treated in one stage, which for reconstruction required the use of sliding plasties and free skin grafts, is reported.

RESULTS: The outcome was satisfactory. Primary closure after wide excision using plastic-surgery techniques may help us resolve complex situations and obtain good results and a rapid recovery.

CONCLUSION: The method of closure with a combination of skin flaps and skin graft in one stage can be considered a valid surgical option for a group of patients with extensive perianal hidradenitis.

Publication Types: Case ReportsPMID: 12838364 [PubMed - indexed for MEDLINE] ... =iconabstr


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Clindamycin and rifampicin combination therapy

Postby patoco » Tue Jul 03, 2007 1:16 pm

Clindamycin and rifampicin combination therapy for hidradenitis suppurativa.

Br J Dermatol. 2006 May

C.O. Mendonça and C.E.M. GriffithsThe Dermatology Centre, Hope Hospital, The University of Manchester, Salford, Manchester M6 8HD, U.K.

C.E.M. Griffiths.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory condition affecting apocrine gland-bearing areas of the skin. There is currently no satisfactory treatment.

OBJECTIVES: To assess the efficacy of a 10-week course of combination clindamycin 300 mg twice daily and rifampicin 300 mg twice daily in the treatment of HS. METHODS: Patients who had received combination therapy with clindamycin and rifampicin for HS at one U.K. Dermatology Centre between the years 1998 and 2003 were identified from pharmacy records. Their records were analysed retrospectively.

RESULTS: Fourteen patients with HS had received treatment with combination therapy. Eight of these patients achieved remission and a further two achieved remission when minocycline was substituted for clindamycin. Four patients were unable to tolerate therapy.

CONCLUSIONS: This small retrospective study indicates that combination therapy with clindamycin and rifampicin may be effective for HS. However, there is a need for a placebo-controlled trial. ... 06.07155.x
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Hidradenitis suppurativa in 64 female patients:

Postby patoco » Tue Jul 03, 2007 1:18 pm

Hidradenitis suppurativa in 64 female patients: retrospective study comparing oral antibiotics and antiandrogen therapy.

J Cutan Med Surg. 2007 Jul-Aug

Kraft JN, Searles GE.

BACKGROUND: Hidradenitis suppurativa (HS) is a recurrent disease confined to apocrine gland-bearing areas causing painful, deep-seated lesions and draining sinus tracts. Uniformly effective therapy is lacking. Improvements in current medical management strategies are needed.

OBJECTIVE: We sought to determine the success rate for a variety of treatments in our female HS patients and whether androgen-related tests can predict a response to antiandrogen therapy. As HS has been linked to a hyperandrogen state, we sought to determine if it is also associated with polycystic ovary syndrome (PCOS).

METHODS: A retrospective chart review was performed examining hormonal profiles and the response to a variety of treatments in female patients with HS.

RESULTS: Sixty-four female HS patients were identified (mean age 33 years). Antiandrogen therapy was superior to oral antibiotic therapy (55% vs 26%) based on a two-sample, two-sided, t-test statistic (p < .04). The prevalence of PCOS among our study patients in whom androgen markers were available was 8 of 21 (38.1%), and even if taken over all study patients, not necessarily investigated for PCOS, the prevalence was 8 of 64 (12.5%). This reflects a greater than expected prevalence among all women (10%).

CONCLUSION: As a proof-of-concept study, despite limitations inherent in a retrospective chart review, there is sufficient signal to suggest that a hormonal manipulation approach to therapy should be considered in all women presenting with HS. Female patients presenting with HS should prompt investigations for underlying PCOS and insulin resistance.

PMID: 17601419 [PubMed - in process] ... d_RVDocSum
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