HYDRADENITIS [hidradenitis; grech, hidros sweat + aden of iron + - itis; synonym: tuberous abscess, hidroadenitis phlegmonosa, abscessus sudoriparus (Verneuil), staphylodermia sudoripara suppurativa, outdated name boughs udder] — purulent inflammation of apocrine sweat glands. The disease occurs often, preferential at people of middle age.
Cause a disease staphylococcus, usually golden or hemolitic. Contribute by. hyperhidrosis (see), grazes during the shaving of axillary poles, intertrigo (see), the creating conditions for penetration into channels of glands of stafilokokk, and endocrine disturbances, especially diabetes.
Stafilokokki get into apocrine sweat glands through their output channels. Sometimes glands are involved in process for the second time; the inflammation in these cases begins with a hypodermic fatty tissue where staphylococcus get on limf, to vessels. At children and G. old men it is not observed since apocrine glands develop by the period of puberty, and by an old age their function dies away.
On border of a derma and hypoderma, in the field of an arrangement of apocrine sweat glands — inflammatory infiltrate from polinuklear, connective tissue cells, lymphocytes, eosinophils and plasmocytes join later; infiltrate contains a large number of stafilokokk. Further there occurs purulent fusion of connecting fabric and a parenchyma of sweat glands with formation of abscess.
The clinical picture
At feeling of an itch, small morbidity and feeling of tension in the field of axillary poles (the most frequent localization), is more rare in perineal area or in a circle of a navel and nipples at women (i.e. in zones of localization of apocrine glands), the dense painful node, to dia appears. 0,5 — 1 cm. The node is located in an upper part of a hypodermic fatty tissue, directly under a derma. Then morbidity amplifies, the node increases to 3 hardly in dia., sharply acts in the form of semi-spherical education. Skin over it becomes purple-red color, is accustomed to drinking with infiltrate. Soon the node is softened, the fluctuating abscess which is opened with allocation of a small amount of slivkoobrazny pus is formed. The development cycle of one inflammatory infiltrate lasts 10 — 15 days. G.'s healing happens to formation of a hem.
Often other sweat gland, sometimes several sweat glands is involved in process; extensive, dense, very painful infiltrate with a pulled chicken skin (fig. 4) can develop.
G.'s current can conditionally be divided into three phases: the first phase — small infiltration of fabrics with involvement in process of one sweat gland, skin over a cut can be not changed; the second phase — several sweat glands with purulent infiltration of fabric around them and formation of dense infiltrate of purple-red color are involved; the third phase — education abscess (see), in the started hard cases — phlegmon (see).
G.'s beginning usually acute: the high temperature of a body, a headache, a leukocytosis accelerated by ROE. In cases of consecutive involvement in process of sweat glands the disease accepts hron, a current.
Possible complications: lymphangitis and lymphadenitis, phlegmon, sepsis.
the Diagnosis is based on set a wedge, signs, typical localization of a disease. Differentiate with furuncle (see), lymphadenitis (cm). Differs from G.'s furuncle in semi-spherical shape of a swelling, lack of primary follicular pustule and necrotic core; from lymphadenitis — more superficial arrangement of infiltrate, more acute current.
At G.'s localization in an axillary pole — an immobilization of an extremity (on a kerchief or Dezo's bandage). Antibioticotherapia within 5 — 7 days; the choice of an antibiotic is based on the accounting of sensitivity of microbic flora. Appoint penicillin (intramusculary) on 100 000 PIECES in 4 hours or in the form of dyurantny drugs to the general dose of 2 500 000 — 3 000 000 PIECES to a course at an acute form G. and to 5 000 000 — 7 000 000 PIECES at hron, a recurrent form; semi-synthetic Penicillin (Metitsillin, Oxacillinum, ampicillin) parenterally on 0,25 — 0,5 g 4 times a day to full permission of G. Primenyayut also tetracyclines (chlortetracyclin, etc.) orally on 0,2 — 0,25 g of 4 — 5 times a day, on a course 6,0 — 15,0 g; Rondomycinum is recommended orally on 150 mg 2 times a day, on a course 2,5 — 3,0 g; erythromycin, Oleandomycinum — orally on 200 000 — 250 000 PIECES of 4 — 5 times a day, on a course 5 000 000 — 10 000 000 PIECES; streptocides on the standard dosages. Appoint an autohemotherapy, a pyrotherapy.
Treatment by antibiotics is combined with Ural federal district, UVCh, and also ultrasonic therapy which will be seen daily within 7 — 15 days to a full rassasyvaniye of infiltrate.
Leather in the field of defeat is processed disinfecting solutions (boron-camphoric alcohol, aniline dyes). Apply pure Ichthyolum or a mercury plaster on infiltrate; also sintomitsinovy emulsion (5 — 10%), ointment with Neomycinum (3 — 5%), erythromycin, etc. are recommended. The warming compresses are contraindicated since they cause maceration of skin and can promote spread of an infection.
At a recurrent form carry out a specific immunotherapy (a staphylococcal vaccine, stafilofiltrat, A2 anatoxin, staphylococcal antiphagin, etc.), gamma-globulin, fortifying treatment.
At a softening of infiltrate with formation of abscess (fluctuation) make a puncture with suction of pus and the subsequent introduction of an antibiotic to an abscess cavity or do a small section on the center of an abscess under a local anesthesia or an intravenous anesthesia. Then for active outflow of pus apply bandages with hypertensive solution of sodium chloride before full clarification of a wound; at emergence of granulations — bandages with a sintomitsinovy or levomitsetinovy emulsion (5 — 10%), etc.
At formation of extensive hilly infiltrate, development of phlegmon, especially at the menacing sepsis, Voyno-Yasenetsky's operation is shown, edges consists in broad excision of the inflamed hypodermic cellulose within healthy fabric (under a local anesthesia or an endotracheal anesthesia). In exclusively hard cases resort to full excision of a pilar part of skin and all hypodermic cellulose of axillary area with the subsequent movement of skin rags or use of free skin plastics by the full-layer rag taken from the surface of a hip or a buttock.
At acute and hron, G.'s current, especially at the multiple centers, along with the general treatment (antibiotics, etc.) the roentgenotherapy is shown, leads edges in an initial stage of infiltration to bystry stopping of process, and in later terms — to acceleration of formation of abscess. Radiation carry out at a voltage of 120 kV, the filter from 3 mm of aluminum, distance a source — skin — 30 cm. In an initial stage of G. — a single dose 15 — 20 I am glad, radiation is done daily to the general dose 45 — 75 I am glad. The effect occurs in the first 1 — 3 day. At radiation in later stages of G. — the single dose increases to 30 — 40 is glad, and the general — to 120 — 160 is glad. Irradiate bucketed in 2 — 3 days.
At emergence of clear fluctuation do a section, without expecting spontaneous opening.
At timely and correct treatment a disease lasts on average 10 — 15 days, however a recurrence is possible.
Observance of rules of personal hygiene, daily washing and rubdown of skin boric or salicyl alcohol, deodorants; treatment of a hyperhidrosis, intertrigo, endocrine disturbances and others patol, the states promoting emergence of. Frequent shaving of hair in an axillary pole is not recommended.
Bibliography Arutyunov V. Ya. Skin and venereal diseases, M., 1972; White G. B. Pustulous diseases of skin, M., 1963; The Multivolume guide to a dermatovenereology, under. edition of S. T. Pavlov, t. 2, page 191, 221, L., 1961; The Multivolume guide to surgery, under the editorship of B. V. Petrovsky, t. 2, page 248, M., 1964; V. I. Pods, etc. Antibiotics in surgery, M., 1973; P e t of e s J. u. Vibrans U. Zur operati ven Therapie der axillaren Hydradenitis suppurativa, Hautarzt, Bd 23, S. 160, 1972; Pollock W. J., V i r n e 1 1 i F. R. a. R at a n R. F. Axillary hidradenitis suppurativa, Plast. reconstr. Surg., v. 49, p. 22, 1972.
Arkhangelsk, M. B. Galeyev, Yu. G. Elashov.