Rare disease that makes teenagers susceptible to hidradenitis

Ho Chi Minh City Quang, 16 years old, often has boils and infections in his armpits and private areas due to apocrine sweat gland inflammation - a disease that only occurs in about 4% of the population.

Quang was previously diagnosed with chronic dermatitis, which could not be cured with treatment. His condition became severe, so Quang went to Tam Anh General Hospital in Ho Chi Minh City for examination. On January 27, Dr. Dang Thi Ngoc Bich, a dermatologist and cosmetic dermatologist, said that Quang had cellulitis and chronic dermatitis with complications of abscess. This complication causes purulent apocrine apocrine inflammation, also known as boils or ingrown hairs. This is a chronic infection of the sebaceous hair follicles, causing blockage and pus.

According to Dr. Bich, apocrine hidradenitis is a rare disease, with an estimated incidence of less than 4% of the population. If this disease is not treated completely, the pus will penetrate deep under the skin, invade the sweat glands in the affected skin area and slowly spread to the surrounding skin. The disease has periods of decline and outbreak. When favorable conditions such as stress, eating a lot of sweets, and a weakened immune system occur, the disease will recur.

The results of the in-depth ultrasound showed that Quang's armpit skin was thick, edematous, and fibrotic. The subcutaneous fat layer had many lumpy fluid collections (abscesses). The largest abscess was 5 cm wide and nearly 1 cm deep, with holes leaking out to the skin surface and many channels running through the surrounding fat layer, containing pus and air bubbles.

After 10 days of taking and applying antibiotics and anti-inflammatory drugs, Quang's inflammation and abscesses had reduced and stopped oozing. In subsequent follow-up visits, the inflammation was well controlled, the skin in the armpit area was no longer red and inflamed, the boils had completely subsided, and the skin ulcers had also healed.

Quang was injected with botox into two areas under his arms to inhibit the nerve pathways responsible for activating sweat glands, reducing underarm sweating and preventing recurrence of hidradenitis.

Dr. Bich noted that treating hyperhidrosis with Botox is not permanent, Quang needs to have repeat injections every 6 months to maintain the effect. Botox starts to take effect after about a week and hyperhidrosis improves significantly after two weeks. Contracture scars, keloid scars, and hyperpigmented scars will be treated with IPL (intense pulsed light technology), releasing fibrous bands... when the furuncle is well controlled.

Doctor Ngoc Bich examines a patient's skin. Illustration: Nguyen Tram — Doctor Ngoc Bich examines a patient's skin. Illustration: *Nguyen Tram*

Hidradenitis suppurativa usually starts from puberty to 40 years old, and is rare. In more than 20,000 dermatological examinations at Tam Anh General Hospital in Ho Chi Minh City in the past year, only 4 cases of this disease were recorded. Previously, a 14-year-old boy was treated stably with a similar regimen as Quang.

The cause of boils has not been specifically determined. The disease can occur due to blocked hair follicles, sweat gland dysfunction, immune regulation disorders, bacterial infections and chronic inflammation... Common locations of sweat gland inflammation are armpits, groin, buttocks, buttocks, thighs.

Hidradenitis suppurativa causes patients to have constant pain, pus causing a fishy smell, post-acne scars contract, fibrosis limits movement, and is unsightly. Many people are self-conscious, afraid to communicate, may be depressed, and have a reduced quality of life.

There is currently no cure for boils, only symptomatic treatment and prevention of re-inflammation by reducing excessive sweating, according to Dr. Bich. Depending on the severity of the disease, doctors may prescribe antibiotics, anti-inflammatories, botox injections, microwave technology, surgery or biological therapy.

To prevent the disease, Dr. Bich recommends that everyone keep their body clean and dry. Avoid rubbing damaged skin areas. Do not share towels or clothes with others. If you have boils, especially in private areas (armpits, groin), you need to see a dermatologist for proper treatment to avoid complications such as suppurative apocrine sweat gland inflammation.

Patients should maintain a reasonable weight, wear loose clothing, limit shaving or plucking hair and beard. They should give up habits such as smoking, drinking alcohol; reduce sugar in the diet and keep a comfortable spirit.

When boils recur, in addition to returning for a check-up and following the doctor's instructions, patients can apply warm compresses to relieve pain. Absolutely do not scratch or squeeze boils to avoid more serious infections.

Anh Thu

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