Acne Conglobata

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Acne Conglobata

Hidradenitis suppurativa

Hidradenitis suppurativa or HS is a skin disease that affects areas bearing apocrine sweat glands and hair follicles; such as the underarms, groin and buttocks, and under the breasts in women.

Contents

Overview

The disease manifests as clusters of chronic abscesses or boils, sometimes as large as baseballs, that are extremely painful to the touch and may persist for years with occasional to frequent periods of inflammation, culminating in drainage, often leaving open wounds that will not heal. Drainage provides some relief from severe, often debilitating, pressure pain. Flare-ups may be triggered by stress, hormonal changes (such as monthly cycles in women), humid heat, and clothing friction. Persistent lesions may lead to scarring and the formation of sinus tracts, or tunnels connecting the abscesses under the skin. At this stage, complete healing is usually not possible, and progression varies from person to person, with some experiencing remission anywhere from months to years at a time, others may worsen and require surgery in order to live comfortably. Occurrences of bacterial infections and cellulitis (deep tissue inflammation) may occur at these sites. HS pain can be difficult to manage.

HS often goes undiagnosed for years because patients are too ashamed to speak with anyone. When they do see a doctor, the disease is frequently misdiagnosed or prescribed treatments are ineffective, temporary and sometimes even harmful. There is no known cure nor any consistently effective treatment. Carbon laser surgery is currently considered the last resort for those who have advanced to its highest stage, where the affected areas are excised, and the skin is grafted. Surgery doesn't always alleviate the condition, however, and can be very expensive.

It is possible that there is genetic predisposition to the disease. (Gao, et al., 2006) HS is not contagious, and isn't affected nor caused by good or bad hygiene. HS is often called an 'orphan illness', due to little research being conducted on the disease at this time. Because HS is considered a rare disease, its incidence rate is not well known, but has been estimated as being between 1:24 (4.1%) and 1:600 (0.2%).

Other names for HS

Hidradenitis suppurativa has been referred to by multiple names in the literature, as well as in various cultures. Some of these are also used to describe different diseases, or specific instances of this disease.

  • Acne conglobata
  • Acne Inversa (AI)
  • Apocrine Acne
  • Apocrinitis
  • Fox-den disease
  • Hidradenitis Supportiva
  • Pyodermia sinifica fistulans
  • Velpeau's disease
  • Verneuil's disease

Stages

HS presents itself in three stages.

1. Solitary or multiple isolated abscess formation without scarring or sinus tracts. (A few minor sites with rare inflammation; may be mistaken for acne.)

2. Recurrent abscesses, single or multiple widely separated lesions, with sinus tract formation. (Frequent inflammations restrict movement and may require minor surgery such as incision and drainage.)

3. Diffuse or broad involvement across a regional area with multiple interconnected sinus tracts and abscesses. (Inflammation of sites to the size of golf balls, or sometimes baseballs; scarring develops, including subcutaneous tracts of infection - see fistula. Obviously, patients at this stage may be unable to function.)

Causes

As this disease is poorly studied, the causes are controversial and experts disagree. However, potential indicators include:

  • post-pubescent
  • females are more likely than males
  • genetic predisposition
  • plugged apocrine (sweat) gland or hair follicle
  • excessive sweating
  • bacterial infection
  • sometimes linked with other auto-immune conditions
  • androgen dysfunction
  • genetic disorders that alter cell structure

The historical understanding of the disease is that there is a misfunction in either the apocrine glands or hair folliciles, possibly triggered by a blocked gland, creating inflammation, pain, and a swollen lesion. More recent studies imply there is an autoimmune comonent. HS is not caused by any bacterial infection -- any infection is secondary. Most cultures done on HS lesions come back negative for bacteria, so antibiotics should be used only when a bacterial infection has been confirmed by a physician.

Hidradenitis suppurativa is NOT contagious!

Severe Complications

Left undiscovered, undiagnosed, or untreated, the fistulas from severe stage-3 HS can lead to the development of squamous cell carcinoma in the anus or other affected areas.

Treatments

Treatments may vary depending upon presentation and severity of the disease. Due to the poorly-studied nature of this disease, the effectiveness of the drugs and therapies listed below is not yet clear, and patients should discuss all options with their doctor or dermatologist. A list of treatments that are effective for some patients is as follows.

  • changes in diet
  • warm compresses, baths (to induce drainage)
  • intralesional corticosteroid injections (to reduce inflammation)
  • incision and drainage or lancing
  • oral antibiotics (to treat inflammation and bacterial infection)
  • isotretinoin (Accutane®), a prescription-only oral acne treatment (benefits for HS are very controversial)
  • wide local excision (with or without skin grafting), or laser surgery
  • radiotherapy
  • anti-androgen therapy
  • sub-cutaneous injection or IV infusion of anti-inflammatory (anti-TNF-alpha) drugs such as infliximab (Remicade®)and etanercept (Enbrel®). This use of the drugs is not currently Food and Drug Administration (FDA) approved and is somewhat controversial, and therefore may not be covered by insurance.
  • Acitretin
This article (or parts thereof) is copied from an article on Wikipedia.org - the free encyclopedia created and edited by online user community. Although the vast majority of the wikipedia encyclopedia articles provide accurate and timely information please do not assume the accuracy of any particular article. This article is distributed under the terms of GNU Free Documentation License.

Articles from About.Com

Three Additional Strengths of Solodyn Approved

Three additional strengths of the acne medication Solodyn (extended release minocycline) have been approved by the FDA. This brings the available strengths of this acne medication up to eight.

Since the strength you need is determined by your weight, these additional strengths will allow doctors to be more precise in dosing Solodyn.

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Three Additional Strengths of Solodyn Approved originally appeared on About.com Acne on Thursday, September 2nd, 2010 at 01:16:52.

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Why Do We Pop Pimples?

I do it. You probably do too. Even though we know we shouldn't squeeze blemishes, sometimes it's tough to stop yourself.

So, why do we pop pimples? I was curious enough about it to ask a dermatologist who is also a clinical psychologist this very question. Who better to provide some insights on why we feel the need to pop, pick, and squeeze our zits.

The good doctor filled me in on what drives us to pick, and if it's ever OK to pop that pimple (and the answer isn't what you think.)

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Why Do We Pop Pimples? originally appeared on About.com Acne on Saturday, August 28th, 2010 at 23:30:30.

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Possible Link Between Long-Term Antibiotic Use and Inflammatory Bowel Disease

A study published in the recent issue of The American Journal of Gastroenterology shows a possible link between long-term use of tetracycline antibiotics and inflammatory bowel disease (IBD).

This comes on the heels of another study, published in the same journal earlier this year, linking isotretinoin (better known as Accutane) to IBD. The link between isotretinoin and IBD was brought into the public eye after several lawsuits against Accutane's manufacturer.

British researchers wondered if long-term use of oral antibiotics might also be a culprit in IBD development, since most people who've used isotretinoin first try antibiotics to clear acne.

According to the study, those who took tetracycline-class antibiotics, particularly doxycycline, had a higher incidence of IBD. It's also possible that using antibiotics prior to isotretinoin use could raise the chances of IBD.

Still, the study did show IBD, even among oral antibiotic users, is rare. And while it raises questions about the role both antibiotics and isotretinoin may have in the development of IBD, there isn't evidence to suggest changing the way doctors treat severe acne.

It's important to remember that all medications come with potential side effects. You should weigh the possible side effects of treatments against the side effects of severe acne itself -- scarring, depression, and possible damage to the self-esteem.

As of yet, these drugs are the best we have to treat severe, inflammatory acne. Many people have used them safely, but they aren't for everyone. Work closely with your doctor, voice any concerns you have, and fill your doc in on any side effects that develop.

Source: Margolis DJ, Fanelli M, Hoffstad O, Lewis JD. "Potential Association Between the Oral Tetracycline Class of Antimicrobials Used to Treat Acne and Inflammatory Bowel Disease." American Journal of Gastroenterology;  10 Aug 2010 doi:10.1038. 23 Aug 2010.

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Possible Link Between Long-Term Antibiotic Use and Inflammatory Bowel Disease originally appeared on About.com Acne on Tuesday, August 24th, 2010 at 20:18:31.

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Skin Care Tips for College-Bound Students

College-bound kids (and their parents) are in the last push of getting everything in order before heading off to school.

Even though you may be leaving high school behind, acne can still be hanging around. It's common for college-aged students to be struggling with the affects of acne that appeared during the teen years.

Add on top of that the stress of a new school, new classes, and most likely a new address, and your skin might start behaving badly. Even good stress, like the excitement of heading off to college and all the work that comes with it, can be enough to worsen acne.

Don't forget to take your acne medications with you as you head off to school, and make sure you have a plan to continue getting your prescriptions while your away from home. If stress does a number on your skin, take some time for stress-relieving activities.

And during those first few crazy hectic weeks at your new school, don't neglect your skin care. Our About.com Skin Care Guide has put together a list of clear-skin tips just for college students.

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Skin Care Tips for College-Bound Students originally appeared on About.com Acne on Saturday, August 21st, 2010 at 16:20:36.

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Justin Bieber Is the New Face of Proactiv

Seems like Justin Bieber is everywhere.  (Those of you who don't know who he is obviously don't have an eleven-year-old daughter, like I do.)

But Justin is now the new face for the Proactiv line. Doing so, he's joining the ranks of other celebrities like Jessica Simpson, Avril Lavigne, and Katy Perry.

Does Justin Bieber really use Proactiv? I have no idea. I don't even know if he even has acne, although being smack in the middle of the teen years I'd be surprised if he didn't get pimples every now and then.

For the teen girls who just can't get enough of him, there is a Justin Bieber video on the Proactiv site. Proactiv is even giving out Justin Bieber posters when you purchase a Proactiv Plus for Teens package.

I'll give Proactiv credit, they've done a great job getting big celebrities to endorse their product, and this may be why Proactiv is so popular. But Proactiv isn't the only 3-step acne treatment option available.

If you stop by your local drugstore you'll find there are many complete acne skin care systems on the market. These won't come with a free Justin Bieber poster, though, (which is either a good thing or bad, depending on your point of view.)

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Justin Bieber Is the New Face of Proactiv originally appeared on About.com Acne on Saturday, August 14th, 2010 at 20:08:05.

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OTC Treatments for Body Acne

When my clients they tell me they have body acne, it's always in a low voice, almost a whisper. Like it's a condition I've never heard of before. They seem surprised that I'm not surprised.

Having acne on your back, or chest, or shoulders, or butt, is common! Lots of people have body acne, even if they don't have acne on their face. There are also many products you can buy over the counter specifically made to treat body breakouts.

Body washes are easily found at any store that sells skin care. They're super easy to use -- just apply them to a washcloth or shower poof and lather up. You can find inexpensive options, like Oxy Hydrating Body Wash, or splurge on more boutique products like Murad's Acne Body Wash.

Body sprays are another option. The benefit to body sprays is their ease of use, plus you can apply them at any time (not just when you shower.) Plus, because these are leave-on treatments, you may see quicker results.

Some acne body spray options include Neutrogena Body Clear Body Spray or, our About.com Skin Care Guide's favorite body acne treatment, Nature's Cure Body Acne Spray.

Treatment lotions, creams, and gels are also great leave-on treatments. The downside is, depending on where acne is on your body, they can be hard to apply.

Whatever treatment product you choose, make sure they include the most effective OTC acne-fighting ingredients: salicylic acid, benzoyl peroxide, or sulfur. (Benzoyl peroxide can stain clothing, though, so be sure you take that into account if you're using a BP treatment.)

Body acne is super stubborn, so be consistent with your treatments and be patient. Some body acne just won't respond to OTC products, no matter how good your home care is. In this case, it's time to call in the pros. Your doctor has plenty of medications to help you beat body acne.

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OTC Treatments for Body Acne originally appeared on About.com Acne on Tuesday, August 10th, 2010 at 16:36:10.

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"Miracle Mineral Solution" Won't Cure Acne, Can Make You Sick

The FDA is warning people not to drink Miracle Mineral Solution (MMS). MMS is sold by independent distributors online, and claims to treat a host of problems including acne, hepatitis, flu, HIV, plus many others.

When MMS is mixed as directed on the package, it produces an industrial-strength bleach (yikes!). The FDA has already received reports of people becoming very sick after taking this product.

If you happen to be taking this product, the FDA recommends you stop using it immediately and throw it away. For more info, you can visit the FDA website.

There are so many products advertised on the internet (and elsewhere) claiming to be a definitive treatment for acne, but this proves again that we need to be super careful about anything we're putting on, or in, our bodies.

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"Miracle Mineral Solution" Won't Cure Acne, Can Make You Sick originally appeared on About.com Acne on Wednesday, August 4th, 2010 at 16:52:08.

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Choosing an OTC Product

Most of us head straight for the skin care aisle when acne rears its head. And fortunately, there are some fairly effective OTC treatment options on the market.

But choosing one can seem overwhelming. Who hasn't compared acne treatment cleansers, lotions, scrubs and solutions, wondering which one would be the best choice?

For OTC products, the most effective ingredients will be benzoyl peroxide, salicylic acid, (and sulfur to a lesser extent) or a combination of these. Start your search by focusing on products that contain these ingredients.

Products that contain the same active ingredients will work in generally the same way, so feel free t choose whichever brand you like best. If you don't notice an improvement after several weeks, you may want to switch products.

Do try one with a different active ingredient. Because benzoyl peroxide and salicylic acid work in different ways, one might give you better results than the other.

Not all acne can be treated with OTC products, so if you don't see improvement don't hesitate to give your doctor a call.

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Choosing an OTC Product originally appeared on About.com Acne on Friday, July 30th, 2010 at 00:28:22.

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Video: How To Remove Makeup

Even a trace of makeup can contribute to pore blockages and breakouts. Are you sure you're properly removing all your makeup?

This video give you step-by-step instruction for perfectly clean, bare skin. To avoid further breakouts, make sure all makeup removing products are non-comedogenic and oil-free

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Video: How To Remove Makeup originally appeared on About.com Acne on Monday, July 26th, 2010 at 00:24:24.

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Comedonal Acne Common in Women who Smoke

Inflammatory acne on the cheek, chin, jawline and neck that tends to wax and wane with the menstrual cycle is considered the hallmark of adult-onset acne in women. But another type of acne is getting some attention -- post-adolescent comedonal acne.

Researchers say comedonal acne is even more common in women than inflammatory acne. And here's the interesting part -- if you smoke you are much more likely to develop comedonal acne.

Among women taking part in a research study (soon to be published in the Journal of the American Academy of Dermatology) nearly 73% with comedonal acne were confirmed smokers. Being a smoker doesn't seem to increase inflammatory acne.

Many ladies, because they rarely get the "typical pimple," are surprised when they are diagnosed with acne. But those non-inflammatory bumps and blackheads are a type of acne.

In my personal experience, among my clients with comedonal acne most have been smokers. Many of them saw an improvement in their skin after they quit smoking.

Are you ready to quit? The Quit Smoking Toolbox, put together by our About.com Guide to Smoking Cessation, will help you on your path to becoming a non-smoker.

Source: Capitanio B et. al. "Underestimated clinical features of postadolescent acne." J Am Acad Dermatol 2010; Advance online publication, doi:10.1016/j.jaad.2009.11.021.

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Comedonal Acne Common in Women who Smoke originally appeared on About.com Acne on Monday, July 19th, 2010 at 22:56:25.

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