Hidradenitis suppurativa
Introduction
Introduction to suppurative sweat gland inflammation After apocrine gland infection, it recurs in the intradermal and subcutaneous tissues, spreading widely, forming a wide range of chronic inflammation, small abscess, complex sinus and fistula, called suppurative sweaty gland inflammation (suppurativehidrosadenitis), 20 to 40 years old body fat People who are sweaty are prone to this disease. Women are more than men. The disease may be malignant for a long time, and most of them occur 10 to 20 years after the disease. basic knowledge The proportion of illness: 0.002% Susceptible people: those who are obese and sweaty in 20 to 40 years old Mode of infection: non-infectious Complications: abscess
Cause
Causes of suppurative sweat gland inflammation
(1) Causes of the disease
The pathogen is mainly Staphylococcus aureus, which can be caused by Escherichia coli or Proteus in the vulva and anus, obesity, hyperhidrosis, poor local hygiene, scratching and other factors, all of which are easy to induce the disease, for some reasons, such as The keratinization or elimination of the apocrine glands may cause bacterial infection and cause the disease. The disease may be associated with polymeric acne and suppurative perforating follicular inflammation, called follicular declusion triad.
Chinese medicine believes that this disease is mostly due to weak qi, wet and hot infestation, bet on the perianal, and the implication is not scattered; or the heart and spleen are both deficient, the health is derelict, the phlegm is endogenous, and the anus is formed.
Modern medicine believes that the cause of this disease is complex, may be related to hormone imbalance in the body, embryonic dysplasia, local moisture, excessive smoking, bacterial infection and other factors, bacteria invade sweat glands, hair follicles and the conduits that communicate with each other, rapidly proliferate, release oxytetracycline Inflammation of the gland, edema, obstruction, suppuration, spread under the skin, forming multiple abscesses, during which the narrow passages are connected to each other, resulting in repeated infections, the pathogens are mostly Staphylococcus aureus, streptococcus, anaerobic bacteria and anaerobic Streptococcus oxidans, the bacteria infected by this disease have certain regularity, the sputum is mainly Staphylococcus aureus and anaerobic bacteria, especially the semi-negative cocci, the perineum is mainly anaerobic streptococci; the anus and genitals are mainly Group F streptococcal infection.
The apocrine glands, sebaceous glands and the hair follicles where they open are controlled by androgen in development. The puberty begins to secrete. The highest peak of activity is in the sexually active period. After menopause, the apocrine glands gradually shrink and the secretory function is obviously weakened. The incidence of this disease is completely consistent with the activity of the apocrine gland. It never occurs before puberty, and does not occur after menopause. It is reported in the literature that one case of this disease occurs after the use of androgen in humans. Therefore, both physiologically and pathologically, Both indicate that the disease is an androgen-dependent disease.
Local hygiene is poor, sweating, smoking, scratching, friction and other stimulating factors are easy to induce the disease.
(two) pathogenesis
Shelleyhe and Cahn (1995) found in the experimental model that after the adhesive tape blocked the hair follicle, bacterial infection can cause keratinous embolization of the distal apocrine duct, expansion of the apocrine duct, inflammation, and rupture of the blocked apocrine duct. The inflammation spreads to the adjacent apocrine glands, forming an abscess, ulceration, and fibrosis.
Prevention
Suppurative sweat gland inflammation prevention
1. Pay attention to skin hygiene, strengthen physical exercise, increase skin's resistance, and avoid cold water bathing when sweating.
2. Maintain the integrity of skin function. For skin diseases, especially pruritic skin diseases, timely treatment should be carried out to prevent skin damage and avoid scratching and skin friction.
3. Clothes, towels, basins, etc. are prohibited from being used in public to prevent contact with infection. The patient should be properly isolated. The dressings and contact materials used by the patient should be strictly disinfected or burned. During the illness, it is forbidden to use the liquid to clean the skin lesions. Wash the affected area with tap water to prevent extension.
4. When you are sick, you should refrain from drinking alcohol or spicy food, and eat less thick food.
Complication
Suppurative sweat gland inflammation Complications
1. Subcutaneous abscess.
2. Cellulitis.
Symptom
Symptoms of suppurative sweat gland symptoms common symptoms thin pustular lymph node pain edema purulent secretions excessive skin oil
Suppurative sweat gland inflammation often occurs after puberty, often occurs in the health of the body, excessive skin oil, often young people with hemorrhoids, starting from the perineal perineum, scrotal area single or multiple, subcutaneous or intradermal size Inconsistent, inflammatory cord-like induration consistent with sweat gland hair follicles, pustules or carbuncles, ulceration after ulceration, sacral formation, redness and swelling, conscious pain, discharge of malodorous paste-like purulent secretions, but lesions Only under the skin, not deep into the internal sphincter, with the formation of the first sinus, many sinuses are formed one after another, fused into a piece, extensive necrosis under the skin, skin ulceration, can be extended around the anus, scrotum, labia, appendix, buttocks The waist and thighs often cause hardening and scar formation after healing. Frequent fever, general malaise, swollen lymph nodes and edema in the perianal area, weight loss in the late stage, anemia, or complications such as endocrine and fat metabolism. symptom.
Examine
Examination of suppurative sweat glands
1. Endocrine examination.
2. Khan gland secretions for bacterial culture.
Histopathology: There are many neutrophils near the apocrine glands at the beginning, and there are dense clusters of staphylococci. Later, the sweat glands can also be affected. There are more lymphocytes and plasma cells infiltrated around the blood vessels, and finally the glands are destroyed. There are foreign body giant cells infiltrating around, and the skin attachments are destroyed and extensive fibrosis is formed.
Diagnosis
Diagnosis and differentiation of suppurative sweat gland
Lymphadenitis nodules are large, solid, inflammatory infiltration is deep, and there is a suppurative lesion nearby.
In addition, ulcerative damage needs to be differentiated from skin sputum tuberculosis. Inguinal lesions should be differentiated from inguinal granulomatosis and sexually transmitted lymphogranuloma. The nodules and sinus in the perineal area should be excluded from the sigmoid diverticulum and Crohn's disease. Symptoms and serology, histopathology, etc.
1. : Follicular infiltration is obvious, conical, with pus at the top after rupture, the course of disease is short, and there is no need for a good site.
2. Lymph node inflammation: nodules are large, solid, inflammatory infiltration is deep, and there are infected lesions nearby.
3. Complex anal fistula: The pipeline is deep, there is granulation tissue inside, often there is internal mouth, and there is a history of anorectal abscess.
4. Latent follicular sinus: Almost always located in the posterior part of the perineal sulcus, and in many cases, hair is found in purulent secretions.
5. Teratoma: The fistula is very deep, often into the obvious abscess.
