Nikki Sommer, a nurse with Key West Surgical Group, joined Good Morning Keys on KeysTalk 96.9/102.5 FM for Medical Matters this morning.
Chronic skin conditions can cause a lot of problems. Hidradenitis suppurativa or acne inversa can be quite painful. It’s basically, by definition, when the acne goes inside instead of out.
Sommer said, “The reason why I talk about it is Key West Surgical Group both Dr. Larrauri and Dr. Smith have seen several patients with this. It’s not common, but they we do have, and have seen a few, and treatment is very difficult to control. It could be, I don’t want to say, debilitating, but it’s kind of something that doesn’t go away. You’ll get it to be at bay, where it’s not active, and then some things can turn it and it becomes an infectious process.”
The condition causes small, painful lumps under the skin.
Sommer said, “They’re like really large boils that that can tunnel and then create scars. Then the scars really, like thicken the skin, and then they can just, I want to say, reactivate over and over again. We’ve usually mostly seen it under the arms and in the genital, groin area.”
What causes it?
Sommer said, “You have two types of sweat glands that eccrine glands and the apocrine glands. The eccrine glands, they secrete the watery fluid and empty directly on the surface of your skin. They are all over your body. The apocrine glands secrete an oily substance that has an odor. They empty into the deep hair follicles and are usually concentrated in the armpit, the breast, the buttock and the groin. When the hair follicles and the pores they get clogged, the bacteria kind of gets trapped inside your skin and continue to produce sweat, but there’s no way for it to escape, and that is how the infection occurs.”
Women are three times more likely to develop this.
Sommer said, “It can start after puberty, before the age of 40.”
What is the process that makes this happen?
Sommer said, “It starts as a pimple or a boil, or like an abscess, and then the hair follicle, the sweat produced by the glands, the infection is deep in the skin. So again, it continues just to produce that bacteria. So the lesions have different stage stages that they form. So obviously there’s stage one, where the abscess, or the pimple becomes large and painful. It can be there for months. It has a really bad odor to it. It can leave a scar, and it says reappear, but I don’t think it really ever goes away. It just kind of subsides for a bit of time, then multiple can appear so they increase in number, and then it’s tunneling. What that means is, instead of it pushing out, it goes deeper into the body, so beneath the skin surface, and it tracks downward, which makes it then more hard for treatment to reach the area of where the infection is. This is how scars form when it goes deeper into the tissue.”
The infection goes deep into the skin.
Sommer said, “It’ll grow large. I’ve seen it really bad, where it starts in the groin, and then it goes all the way down, especially women, it’s all in the private area, or their underarms, or multiple lesions under their arms. And it’s, it’s very uncomfortable, and it does have a terrible odor. There’s nothing that they’re doing wrong.”
What is the treatment?
Sommer said, “There’s several treatment options. It’s really hard to get them to go away. So first of all, if you’re a smoker, you need to stop smoking, because it can worsen HS. Obesity is another factor. If you’re extremely overweight, it can exacerbate this condition. The follicles, they turn into boils, like we talked about, so you have to be careful shaving and actually, laser hair removal might be effective. While we were in Las Vegas, we met a doctor who treats people with laser for this condition, and she’s had successful results. So that is why I picked this topic, because from a surgical standpoint, both the doctors have treated it, and the usual treatments can be topical, oral antibiotics, retinoids, cleansing the skin with acne, washes, pain medication, not so much. Tylenol and ibuprofen, steroids and anti inflammatory medications. Some people have tried the biologic medications you see them on TV for all those autoimmune disorders, or a tumor necrosis factor. Those are those biologics where you would have to give yourself an injection or an infusion. In extreme cases, surgery has been performed to drain it, try and get the tunnel, if the abscess is trapped deep down in a tunnel, you might need surgery to try and get down to that infection. Laser hair removal, because it slows down the hair growth, and that is where this bacteria can get trapped. However, the PicoSure laser, so this doctor in Texas, she has both a laser hair removal and the PicoSure and she said it has been great in treating HS, as well as acne and cystic acne, because the laser can target deep down and get to that bacteria where a lot of times nothing else can. She’s had very successful treatment using the laser, the Pico laser, in treating this. So while talking to her, thinking of all the patients we’ve taken care of in the past, some have moved away, but I was like, oh, this would be great. It was eye opening, just talking to the different providers and how they use the laser in their practice, whether it’s for esthetic and in this case, it’s a medical condition. Now, insurance won’t cover the laser for the condition, but it is an option to treat for the condition.”
For more information, click here: https://www.keywestsurgicalgroup.com/