Gidradenit — the purulent inflammatory process happening in apokrinovy sweat glands at penetration into them of a staphylococcal infection. In most cases there is a defeat of apokrinovy glands of axillary hollows. But can meet gidradenit okolopupochny area, inguinal folds, an anus, a scrotum, big vulvar lips. Diagnostics of a gidradenit is performed on a clinical picture, characteristic of it. Crops separated with antibiotikogrammy are made for adequate selection of antibiotic treatment. Gidradenit it is dangerous by purulent complications up to development of sepsis. Its timely and correct treatment allows to avoid similar complications, however does not exclude repetition of a disease.
Gidradenit never it is observed at children and people of advanced age. It is connected with the fact that functioning of apokrinovy sweat glands begins only by the pubertatny period and dies away at advanced age. The most part of diseases gidradenity (about 85%) are the share of women aged from 16 up to 55 years. Most often gidradenit arises during puberty, at emergence of a hormonal imbalance and in the climacteric period. Various factors leading to development in an apokrinovy sweat gland of infectious and inflammatory process are the cornerstone of a gidradenit.
Causes of a gidradenit
Gidradenit is a purulent disease of sweat glands and treats a piodermiya. Most often golden staphylococcus is the reason of a gidradenit. The activator gets into apokrinovy glands directly through their removing channels or on lymphatic ways through damages of a blanket of skin. Injuries of skin can arise during shaving, when carrying out an epilation or when combing skin because of the itching dermatosis. Constant moknuty and maceration of skin because of the increased perspiration also leads to decrease in its barrier function and penetration of microorganisms.
Development of infectious process in apokrinovy gland happens when weakening protective forces of an organism. Emergence of a gidradenit is promoted: shift sweat in the alkaline party, neglect rules of hygiene, endocrine diseases (violations from gonads, diabetes, obesity), chronic inflammatory processes.
Symptoms of a gidradenit
In most cases gidradenit happens unilateral, but also bilateral defeats meet. At the beginning of development of a gidradenit (an infiltration stage) in skin separate dense small knots of the small size appear. They are followed by an itch and the easy morbidity increasing when pressing by a small knot. Small knots quickly increase in sizes and the dense knots of a pear-shaped form soldered to skin turn in big (to 1,5 cm). They act over the surface of skin, reminding nipples. Skin in the place of formation of knots gains red-blue color, there is a puffiness, strong morbidity is noted. Increasing, separate knots of a gidradenit can merge with each other, forming the poured infiltrate of a dense consistence having the disk-shaped form and similar to a phlegmon picture. At the same time severe pain is noted not only at the movement of the patient, but also at rest. The described clinical picture corresponds to a stage of maturing of a gidradenit. It is followed by the general violations: the indisposition, temperature increase of a body expressed by a pain syndrome.
Further there is a gradual softening of the central part of knots and opening of a gidradenit to release of the pus, on the consistence reminding dense sour cream. Purulent masses may contain blood impurity. The feature distinguishing gidradenit from a furuncle, lack of a necrotic core is. Opening of knot of a gidradenit usually happens in 7-10 days after its emergence and is followed by improvement of the general state and reduction of morbidity. On the place of the opened knot the ulcer which then heals is formed, leaving behind the involved hem.
The full cycle of development of a gidradenit takes about 2 weeks. But on a row with already cicatrizing educations, the located sweat glands involved in inflammatory process by a row can suppurate. Gidradenit accepts a long or chronic recidivous current at which aggravations can arise tens of times. It is more often observed at untimely or inadequate treatment, non-compliance with personal hygiene and at patients with the associated diseases reducing immunity.
Complications of a gidradenit
At a gidradenita of a complication arise generally at the weakened patients or in the absence of treatment. Distribution of purulent process on surrounding soft fabrics without adequate drainage of the purulent center leads to formation of abscess or development of phlegmon. In far come stages of a gidradenit the gnoyerodny infection can get to a blood-groove and be carried on all organism — there is sepsis.
Diagnostics of a gidradenit
Diagnostics is carried out on a characteristic clinical picture of a gidradenit. In clinical blood test inflammation signs are noted: acceleration of SOE, the increased maintenance of leukocytes. For adequate antibiotic treatment of a gidradenit do separated with definition of sensitivity to antibacterial medicines. At a long and recidivous current of a gidradenit conduct a research of immune system of an organism — to an immunogramm.
Treatment of a gidradenit
Patients gidradenity have to keep to a special diet. Within 3 months they need to abstain from hot dishes, alcohol, seasonings, it is necessary to limit consumption of sweets. In too time, food it has to be directed to increase in protective forces of an organism. The vitaminized food rich with phosphorus and iron is recommended: apples, carrots, berries, cabbage, citrus, almonds, walnuts, dogrose, etc. Strengthening of immunity is promoted by intake of polyvitaminic medicines, juice of a plantain or aloe, tincture of a ginseng or an eleuterokokk.
For the prevention of spread of an infection on other sweat glands skin around the centers of a gidradenit 3-4 times a day needs to be wiped with salicylic, boric or camphor alcohol. As water can also promote spread of an infection, it is better to bathe under a shower, previously having closed the place of a gidradenit a bandage with a plaster.
The general therapy of a gidradenit is carried out by the principles of treatment of a piodermiya, generally by antibiotics (doxycycline, erythromycin, etc.). At a recurrence of a gidradenit the immunostimulating treatment which is appointed only according to an immunogramma is shown. At confirmation of the staphylococcal nature of a gidradenit the specific immunotherapy can be applied: staphylococcal gamma globulin, staphylococcal vaccine.
In a stage of infiltration of a gidradenit conservative therapy is shown. In a zone of defeat and around it cut off hair. Make processing of skin over infiltrate antiseptics: 3% solution of diamond green, 96% ethyl alcohol, 2% spirit solution of salicylic acid, 5% iodic tincture, etc. If there is an infiltrate, big on the area, with the expressed morbidity, then produce its obkalyvany 0,5-1% novocaine solution with antibiotics.
The first 3-5 days of a gidradenit are recommended the semi-spirit damp drying bandages. Application of bandages with ointments can cause maceration of skin and promote process distribution. Treatment of different gidradenit compresses contraindicated. It strengthens infiltration and accelerates suppuration. In treatment only dry heat can be used: the terry towel heated by the iron, 5 minute warmings up by a blue lamp at distance of 15-20 cm, solar warmings up in warm season (from 10 to 30 minutes depending on intensity of sunshine).
Ripened (softened) gidradenit is subject to surgical treatment. Usual opening and drainage of a gidradenit does not yield positive result as its infiltrate is presented by a set of microabscesses which at such treatment remain in the center, continue to ripen and produce pus. Opening of a gidradenit is carried out by the wide section passing through infiltrate to healthy fabrics. After evacuation of pus make removal of all infiltrirovanny fatty cellulose.
At the repeating recurrence of a gidradenit make its radical surgical treatment. Surgery consists of 2 stages. At the first stage the purulent center is widely opened and excise all inflamed cellulose. Healing of a wound takes place in open conditions and with obligatory antibiotic treatment. After subsiding of inflammatory processes and emergence of granulations carry out the second stage of expeditious treatment — full removal of skin and hypodermic fatty cellulose of the zone struck gidradenity. Closing of the formed defect is carried out by the moved rags of own skin of the patient (autodermoplastik). Performing radical surgical treatment of a gidradenit one-stage operation not expediently because of frequent suppuration of a postoperative wound after such interventions and its long healing with formation of a rough hem.
From physiotherapeutic methods of treatment to destination of the physiotherapist in a stage of infiltration of a gidradenit application of UVCh, SMV-therapy, local Ural federal district therapy is possible. However some authors do not recommend holding any physiotherapeutic procedures at the beginning of a disease. After expeditious treatment use local infrared radiation, Ural federal district therapy, laser therapy and magnetotherapy. At treatment of recidivous and long forms of a gidradenit appoint ultrasonic therapy, an electrophoresis with dioniny, codeine or unithioscrap.
At the persistent, repeatedly repeating current of a gidradenit X-ray therapy during which there is a destruction of sweat glands can be applied.