whats the best way to treat hidradentitis?

Answer 1

Hydradenitis is inflammation of sweat glands
It is treated by a very dilute acetic acid (vinegar ) application. or frequent soap washes.
Hydradenitis suppurativa is infection f sweat glands by pus producing bacteria , generally Staphylococcus and should be treated with antiiotics.

Answer 2

The severity of the condition varies very much from person to person. It usually persists for many years although it often does eventually disappear.
Treatment

General measures: Overweight patients need to lose weight as, like many other skin disease in skin folds, increased friction appears to make the condition worse. Antiseptic soaps or bath additives for washing are advisable.

Treatment of sudden worsening:this may be due to ordinary bacteria (the types which infect cuts and grazes), so antibiotics such as flucloxacillin may be used as a short course. Frequent episodes of this type, with proven bacterial infection, usually indicate that there is a sinus or abscess (see treatments below).

Suppressive therapy: Antibiotics by mouth are often needed as long-term treatment to suppress attacks. The ones that are used are those which are also used for acne, such as oxytetracycline. Other anti-acne drugs such as isotretinoin (vitamin A derived tablets) may be useful, but have some important side-effects and are only available from dermatology departments. In women who have a pre-menstrual flare of the disorder, tablets known as antiandrogens can be useful - the usual one is cyproterone acetate 50mg taken on days 5-15 of the menstrual cycle in conjunction with an oral contraceptive called Dianette. Previous high blood pressure or blood clots mean that this approach cannot be used.

Treatment of scarred sinuses and abscesses: Persistent discharge or infection in the same site usually indicates that the medical treatments listed above will not work, and a small operation may be required. This may involve either small local operations to remove small areas of repeated inflammation, or a wider procedure to remove all the diseased glands may be needed in some cases.

Answer 3

Emergency Department Care:

The nodules of hidradenitis suppurativa may need to be drained in the emergency department, particularly if they are very large, fluctuant, and painful.
Antibiotics are indicated if cellulitis or fever is present, and the patient should be admitted if he or she appears to be toxic.
Consultations:

General surgery
Surgical consultation may be obtained for removal of sinus tracts, curettage, and exteriorization of the gland.
Excision and skin grafting may be helpful for severe intractable cases. Also, surgery should be considered in early cases because the area to excise is smaller and less damaged from recurrences.
The CO2 laser has been used to strip away glandular tissue. Healing is by secondary intention.
Radiation treatment has also been used for this condition.

MEDICATION Section 7 of 9
Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Bibliography



Tetracycline and erythromycin may be helpful on a long-term basis, and cephalosporins often will help in acute cellulitis. On a short-term basis in the emergency department, dicloxacillin is considered a good choice. However, consideration must be given to using a sulfonamide or clindamycin antibiotic because of the growing presence of methicillin-resistant Staphylococcus aureus (MRSA) for both short-term and long-term treatment. Topical products, such as benzoyl peroxide, may be helpful. Topical and intralesional injections of corticosteroids are sometimes helpful.

Topical clindamycin cream has also been used with some success. Retin-A has rarely been found to be helpful in some patients. Systemic retinoids (Accutane) can reduce the severity of attacks in some patients but is not a reliable cure for hidradenitis suppurativa. Accutane cannot be prescribed in the emergency department due to requirements set forth by the pharmaceutical company. Hormonal manipulation (eg, certain oral contraceptives)has been useful for some patients but is unlikely to be prescribed from the emergency department.


Drug Category: Antibiotics -- Therapy must cover all likely pathogens in the context of the clinical setting. In recurrent disease, antibiotics may be administered for 2 or more months.Drug Name
Tetracycline (Sumycin) -- Treats susceptible bacterial infections of both gram-positive and gram-negative organisms as well as mycoplasmal, chlamydial, and rickettsial infections.
Adult Dose 250 mg PO qid or 500 mg PO tid
Pediatric Dose Condition not seen in children
Contraindications Documented hypersensitivity; severe hepatic dysfunction
Interactions Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy; tetracyclines can increase hypoprothrombinemic effects of anticoagulants
Pregnancy D - Unsafe in pregnancy
Precautions Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last one-half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines
Drug Name
Minocycline (Minocin, Dynacin) -- For the treatment of infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible Rickettsia, Chlamydia, and Mycoplasma.
Adult Dose 100 mg PO bid
Pediatric Dose Condition not seen in children
Contraindications Documented hypersensitivity; severe hepatic dysfunction
Interactions Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy; tetracyclines can increase hypoprothrombinemic effects of anticoagulants
Pregnancy D - Unsafe in pregnancy
Precautions Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last one-half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines; hepatitis or lupuslike syndromes may occur
Drug Name
Dicloxacillin (Dynapen, Dycill) -- Binds to one or more penicillin-binding proteins, which, in turn, inhibit synthesis of bacterial cell walls. For treatment of infections caused by penicillinase-producing staphylococci. May use to initiate therapy when staphylococcal infection is suspected.
Resistance to this drug results from alterations in penicillin-binding proteins.
Adult Dose 125-500 mg PO qid 1-2 h ac or 2 h pc for 7-10 d
Pediatric Dose Condition not seen in children
Contraindications Documented hypersensitivity
Interactions Decreases efficacy of oral contraceptives; may decrease effects of anticoagulants; probenecid and disulfiram may increase penicillin levels
Pregnancy B - Usually safe but benefits must outweigh the risks.
Precautions Monitor PT in patients taking anticoagulant medications; toxicity may increase in patients with renal impairment
Drug Name
Sulfamethoxazole and trimethoprim (Bactrim DS, Septra DS) -- Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid.
Adult Dose 160 mg TMP/800 mg SMZ PO q12h for 10-14 d
Pediatric Dose Condition not seen in children
Contraindications Documented hypersensitivity; megaloblastic anemia due to folate deficiency
Interactions May increase PT when used with warfarin (perform coagulation tests and adjust dose accordingly); coadministration with dapsone may increase blood levels of both drugs; coadministration of diuretics increases incidence of thrombocytopenia purpura in elderly persons; phenytoin levels may increase with coadministration; may potentiate effects of methotrexate in bone marrow depression; hypoglycemic response to sulfonylureas may increase with coadministration; may increase levels of zidovudine
Pregnancy B - Usually safe but benefits must outweigh the risks.
Precautions Do not use during last trimester of pregnancy because of potential toxicity to newborn (eg, jaundice, hemolytic anemia, kernicterus)
Dosage adjustments (adult adjustments)
CrCl (mL/min) 80-50: Recommended IV dose q18h
CrCl 50-10: Recommended IV dose q24h
CrCl <10: Not recommended
HD: 4-5 mg/kg after HD
During peritoneal dialysis: 0.16-0.8 g q48h
Discontinue at first appearance of skin rash or sign of adverse reaction; obtain CBCs frequently; discontinue therapy if significant hematologic changes occur; goiter, diuresis, and hypoglycemia may occur with sulfonamides; prolonged IV infusions or high doses may cause bone marrow depression (if signs occur, give 5-15 mg/d leucovorin); caution in folate deficiency (eg, chronic alcoholics, elderly, those receiving anticonvulsant therapy, those with malabsorption syndrome); hemolysis may occur in G-6-PD deficient individuals; AIDS patients may not tolerate or respond to TMP-SMZ; caution in renal or hepatic impairment (perform urinalyses and renal function tests during therapy); give fluids to prevent crystalluria and stone formation
Drug Name
Erythromycin (E-Mycin, Ery-Tab, E.E.S.) -- Recommended dosing schedule of erythromycin may result in GI upset, causing one to prescribe an alternative macrolide or change to tid dosing. Covers most potential etiologic agents, including Mycoplasma species.
Erythromycin is less active against H influenzae. Although 10 d seems to be a standard course of treatment, treating until the patient has been afebrile for 3-5 d seems a more rational approach. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. For treatment of staphylococcal and streptococcal infections.
Has the added advantage of being a good anti-inflammatory agent by inhibiting migration of polymorphonuclear leukocytes.
Adult Dose 250 mg erythromycin stearate/base (or 400 mg ethylsuccinate) q6h PO 1 h ac, or 500 mg q12h.
Alternatively, 333 mg PO q8h; increase to 4 g/d depending on severity of infection
Pediatric Dose Condition not seen in children
Contraindications Documented hypersensitivity; hepatic impairment
Interactions Coadministration may increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin, increases risk of rhabdomyolysis; decreases metabolism of repaglinide, thus increasing serum levels and effects
Pregnancy B - Usually safe but benefits must outweigh the risks.
Precautions Caution in liver disease; estolate formulation may cause cholestatic jaundice; GI side effects are common (give doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur
Drug Name
Clindamycin (Cleocin) -- Semisynthetic antibiotic produced by 7(S)-chloro-substitution of 7(R)-hydroxyl group of parent compound lincomycin. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Widely distributes in the body without penetration of CNS. Protein bound and excreted by liver and kidneys.
Used for treatment of serious skin and soft tissue staphylococcal infections. Also effective against aerobic and anaerobic streptococci (except enterococci).
Adult Dose 150-300 mg/dose PO q6-8h; not to exceed 1.8 g/d; alternatively, 600 mg IV divided q8h, depending on degree of infection; not to exceed 4.8 g/d
Topical: Apply 2% lotion sparingly over affected area
Pediatric Dose Condition not seen in children
Contraindications Documented hypersensitivity; regional enteritis; ulcerative colitis; hepatic impairment; antibiotic-associated colitis
Interactions Increases duration of neuromuscular blockade induced by tubocurarine and pancuronium; erythromycin may antagonize effects of clindamycin; antidiarrheals may delay absorption of clindamycin
Pregnancy B - Usually safe but benefits must outweigh the risks.
Precautions Adjust dose in severe hepatic dysfunction; no adjustment necessary in renal insufficiency; associated with severe and possibly fatal colitis by allowing overgrowth of Clostridium difficile
Topical dosage form is for external use only, avoid contact with eyes (in event of accidental contact with eye, rinse with copious amounts of cool tap water)
Drug Category: Retinoids -- These agents inhibit sebaceous gland function and keratinization.Drug Name
Isotretinoin (Accutane) -- Decreases sebaceous gland size and sebum production; may also inhibit sebaceous gland differentiation and abnormal keratinization.
Adult Dose 40-60 mg/d PO for 4 mo
Pediatric Dose Condition not seen in children
Contraindications Documented hypersensitivity
Interactions Toxicity may occur with vitamin A coadministration; pseudotumor cerebri or papilledema may occur when coadministered with tetracyclines; isotretinoin may reduce plasma levels of carbamazepine
Pregnancy X - Contraindicated in pregnancy
Precautions May decrease night vision; inflammatory bowel disease may occur; may be associated with development of hepatitis; occasional exaggerated healing response of acne lesions (excessive granulation with crusting) may occur
Diabetes patients may experience problems in controlling their blood sugar level while on isotretinoin; avoid exposure to UV light or sunlight until tolerance achieved; discontinue treatment if rectal bleeding, abdominal pain, or severe diarrhea occur
Mood swings or depression may occur; caution if history of depression
Drug Category: Corticosteroids -- These agents modify the body's immune response to a variety of stimuli. Intralesional injections have been used in addition to the cream.Drug Name
Triamcinolone (Aristocort) -- Treats inflammatory dermatosis responsive to steroids; decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability.
Adult Dose Apply a thin film bid/tid until favorable response
Pediatric Dose Condition not seen in children
Contraindications Documented hypersensitivity; fungal infections
Interactions None reported
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions Do not use in decreased skin circulation; prolonged use, applications over large areas, and use of potent steroids and occlusive dressings may result in systemic absorption; systemic absorption may cause Cushing syndrome, reversible HPA-axis suppression, hyperglycemia, and glycosuria
FOLLOW-UP Section 8 of 9
Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Bibliography


http://www.emedicine.com/emerg/topic259.htm
http://www.rdoctor.com
http://www.nlm.nih.gov/medlineplus
http://www.ncbi.nlm.nih.gov
http://www.cdc.gov
http://www.kavokin.com
http://www.symptomat.com
http://www.webmd.com
http://www.nhsdirect.nhs.uk



Further Inpatient Care:


In severe cases, radical excision of the pathologic tissue with split-thickness skin grafts may be indicated.
Radiation and laser treatments may be considered as well. However, the reason to admit a patient from the emergency department with hidradenitis suppurativa would be due to toxicity or sepsis, so the main treatment would be supportive antibiotics, such as intravenous clindamycin, vancomycin, and piperacillin and tazobactam sodium (Zosyn).
Deterrence/Prevention:


Minimize heat exposure and sweating.
Lose weight if overweight.
Avoid constrictive clothing and frictional trauma.
Avoid underarm antiperspirants and deodorants (this has not been proven to make a difference).
Complications:


Lymphedema due to lymphatic injury from inflammation and scarring
Contracture formation at the sites of lesions
Squamous cell carcinoma (may develop in indolent sinus tracts)
Disseminated infection (rare)
Restricted limb mobility from scarring
Urethral/rectal fistula
Anemia secondary to chronic infection
Arthritis secondary to inflammatory injury
Prognosis:


Individual lesions usually heal slowly in 10-30 days with or without drainage.
Recurrences are common.
Spontaneous complete resolution occurs in rare cases.
Relentlessly progressive scarring and sinus tracts may occur.
Author: Diana Fite, MD, FACEP, Clinical Assistant Professor, Department of Emergency Medicine, University of Texas Medical School at Houston, Hermann Hospital

Diana Fite, MD, FACEP, is a member of the following medical societies: American Association of Women Emergency Physicians, American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Texas Medical Association

Editor(s): Robert M McNamara, MD, FAAEM, Professor of Emergency Medicine, Temple University; Chief, Department of Internal Medicine, Section of Emergency Medicine, Temple University Hospital; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Mark W Fourre, MD, Program Director, Department of Emergency Medicine, Maine Medical Center, Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine; John Halamka, MD, Chief Information Officer, CareGroup Healthcare System, Assistant Professor of Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Assistant Professor of Medicine, Harvard Medical School; and Rick Kulkarni, MD, Assistant Professor of Medicine, David Geffen UCLA School of Medicine; Director of Informatics, Department of Emergency Medicine, UCLA/Olive View-UCLA Medical Center