Disease Description (Causes and Symptoms)
- Definition summary: A chronic, recurrent skin disease that leaves painful nodules, abscesses, fistulas (sinus tracts), and scars in areas such as the armpits, groin, perianal/vulvar area, and under the breasts.
- Causes and pathophysiology: Follicular occlusion is considered the initial pathological mechanism, progressing from follicular rupture → secondary inflammatory response → chronic inflammation, fistula formation, and fibrosis. Because apocrine glands are located in the affected areas, they are often involved; bacteria (e.g., staphylococci) may contribute to secondary infection or persistent inflammation. Genetic predisposition, smoking, obesity, and hormones (androgens) are aggravating factors.
- Main symptoms: Tender nodules (usually recurring repeatedly), erythema, purulent, bloody, or serous discharge, fungus/odor, double comedones, fistulas (interconnected abscesses resembling a honeycomb), and scars. Common in the armpits in women and in the groin and perianal area in men.
- Simple severity classification: Hurley I (localized nodules), II (recurrent abscesses and fistulas), III (extensive fistulas and scarring).
Treatment Methods
- Diagnostic criteria: Diagnosis is primarily based on clinical findings. Culture testing of drainage (exudate) and blood tests (including inflammatory markers) may be performed as supplementary tests. Ultrasound/MRI may be used when necessary to assess the extent of fistulas and abscesses. (Thyroid function testing is not routine but may be performed if indicated by the medical history or clinical suspicion.)
- Medication treatment
- Topical: Application of topical antibiotics such as topical clindamycin (1%) (in mild cases).
- Oral antibiotics: Tetracyclines (doxycycline, minocycline) are first-line; clindamycin plus rifampicin may be used in combination for severe or recurrent cases. Long-term antibiotic therapy provides both anti-inflammatory and antibacterial effects.
- Hormone therapy: In women, spironolactone, progestin regulation, and oral contraceptives may help improve symptoms.
- Topical/injected steroids: Intralesional triamcinolone injections into localized small nodules can relieve pain and inflammation.
- Biologics: Anti-TNF agents (e.g., adalimumab) are approved and used for severe disease or when standard treatment fails.
- Other: Isotretinoin has generally shown limited efficacy in reports (though it is used in some patients).
- Procedures and surgery
- Temporary incision and drainage can provide pain relief only and has a high recurrence rate.
- Deroofing (removal and opening of fistulas) or wide excision is intended to prevent recurrence in moderate or more severe disease or extensive lesions.
- Lasers (e.g., long-pulsed Nd:YAG) or hair removal may help reduce recurrence.
- Lifestyle management
- Smoking cessation, weight loss (obesity management), wearing well-ventilated clothing, appropriate wound and drainage care, and pain control (analgesics), among other measures.
- Precautions (related to treatment)
- Simple self-drainage may worsen the wound and deepen fistulas.
- Monitoring for adverse effects (including drug interactions and infection risk) is necessary when using long-term antibiotics or biologics.
- When planning pregnancy, the safety of medications such as isotretinoin should be confirmed.
- Complications: Chronic scarring and hyperpigmentation, lymphedema, persistent infection, and, rarely, reported development of squamous cell carcinoma (SCC) in chronic lesions.
- Prognosis: The disease follows a chronic, recurrent course, and early aggressive treatment can reduce progression and complications.
Checklist Before an Outpatient Visit (Including Example Questions)
- Items and information to prepare
- A list of currently used medications (including prescription drugs, nonprescription drugs, and supplements) and a history of allergies
- Photos of the lesions (photos showing changes over time can be useful)
- Records of when symptoms began and their recurrence cycle, pain severity (pain score), and changes in the color/amount/odor of discharge
- Records of previous treatments (topical agents, oral antibiotics, surgery, laser treatment, etc.) and their effects/adverse effects
- Smoking status, weight/BMI, menstrual history, and contraceptive use (women)
- Results of previous tests (culture tests, blood tests, imaging tests, etc.)
- Example questions useful to ask during an outpatient visit
- "How have the lesions changed over the past few years?"
- "What medications have you taken, and for how long? What was their effect?"
- "Have there been times when the pain or discharge became worse?"
Examples of General Questions to Ask the Doctor
- What is the goal of this treatment (pain relief, recurrence prevention, minimizing scarring, etc.)?
- What is the recommended first-line treatment (topical or oral medication), and what effects and duration can be expected?
- What are the main adverse effects of the medications (biologics, antibiotics, hormone medications, etc.)?
- What are the criteria for recommending surgery (deroofing or wide excision)?
- Are there any treatment recommendations or restrictions during pregnancy or breastfeeding?
Examples of Disease-Specific Questions
- What is the Hurley stage of my lesions, and what treatment strategy is recommended accordingly?
- There seems to be a connection between my symptoms and menstruation (hormones). Could hormone treatment (spironolactone or contraceptives) help?
- Is this a situation in which biologics such as adalimumab should be considered, and how are the expected benefits and infection risk managed during treatment?
If needed, providing your current symptoms (including photos) and previous treatment history may help with more specific consultation. This material is general information; consult your doctor regarding the final diagnosis and treatment plan.