What is it?

• Chronic, recurrent inflammatory condition with painful skin nodules.  Although the exact cause is not yet understood, contributing factors include:

  • friction from clothing and body folds​

  • unusual immune response to normal body bacteria (commensals)

  • occlusion of hair follicles (similar to acne)

  • release of pro inflammatory molecules from the immune system

  • secondary bacterial infections

  • certain medications

• Common areas include the armpits (axilla), groin, under the breasts, and abdominal folds

• Much more common in women then men – about 1% of the population are affected

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What are the symptoms?

• It is characterized by persistent or recurrent boil-like nodules and abscesses that culminate in a purulent discharge, sinuses, and scarring.

 

Do I need to do any tests as part of the diagnosis?

• In most cases the answer is NO as this tends to be a clinical diagnosis

• Hormone levels are typically normal

• It is rare to have to do a skin biopsy for diagnosing this condition

 

What are the treatment options available?

• No uniformly effective treatment – many different options but often unsatisfactory

  • General measures:

  • Weight loss, low glycemic diet, low dairy diet

  • Smoking cessation

  • Loose fit clothing

  • Antiperspirants to keep skin folds dry, sometimes Botox can help with this

  • Dilute bleach baths if prone to infections

  • Antiseptic washes

  • Dressings and wound care 

  • Pain control with acetaminophen or ibuprofen as needed 

 

1. Antibiotics

• Topical antibiotics with or without benzoyl peroxide

• Oral tetracyclines or dapsone 

• Oral Clindamycin/Rifampin combination

 

2. Hormone based treatments

• Birth control pill

• Spironolactone 

• Metformin

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3. Intralesional steroid injections

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4. Zinc gluconate supplements

 

5. Immune system suppressing medications

• Methotrexate

• Cyclosporine

• Azathioprine

 

6. Retinoids - similar to acne treatments

• Accutane

• Acitretin

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7. Biologics

• Adalimumab - blocks TNFa inflammation

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8. Surgical and laser management

• Incision and drainage of abscesses

• Deroofing of skin lesions (removing the top layer of skin)

• Laser ablation of nodules (CO2)

• Excision of nodules and abscesses

• Surgery of entire area (axillectomy – removing the armpit)

• Laser Hair removal