Vulva Hidradenitis

Hidradenitis

This is a chronic, acneiform eruption involving the axillary, inframammary and anogenital area. Typically there are deep, painful, cystic nodules, sinuses and scarring. This is sometimes referred to as acne mechanica or inverse acne.

Pathophysiology: An acute and chronic follicular occlusive disease like acne vulgaris, it is related to androgen excess and often flares with menstruation. Familial cases are reported so genetic factors likely plat a role.

Clinical: Onsets after puberty with painful 揵oils?in the groin, axillae or both. Typically there is a menstrual flare. Lesions come and go in crops with varying degree of severe pain and discomfort. Red, acneiform papules, nodules and cysts are seen, sometimes with multiheaded comedones. The cysts rupture, leaving sinuses with varying degrees of scarring and incapacity. The diagnosis is clinical, with a biopsy needed only rarely

Management: can be difficult. Stop pressure, friction, and rubbing. Use ventilated cotton clothing. Use of anti-androgens may be considered. Systemic antibiotics as in acne梩etracycline, minocycline. Intralesional steroids can be helpful. Ultimately surgical unroofing of the areas may be necessary. Accutane.