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Q. My gynecologist recently told me I had hidradenitis...

February 25, 1999|By Dr. Allen J. Douma.

Q. My gynecologist recently told me I had hidradenitis suppurativa in the groin area. I've not been able to find much information on it. I would appreciate any help.

A. Hidradenitis suppurativa is a poorly understood and frequently underreported medical condition in which there is inflammation in and around a certain type of hair follicle. These hair follicles are located primarily in the groin, armpit and around the nipples.

A recent study found that as many as 4 percent of people have hidradenitis to some degree, but it's usually not bad enough for them to overcome the cost and embarrassment to seek medical attention.

Hidradenitis is more common in women--occurring most frequently after menopause. Many women report that it flares up just prior to menstruation.

Sometimes it is confused with acne and treated in the same way. But the treatment for acne does not work for hidradenitis. Unfortunately, there is no great medical treatment for it at all.

Oral antibiotics and steroids (both oral and injected), as well as rigorous skin cleaning and the application of antibiotics on the lesions, may help some people. If nothing else, it helps prevent secondary bacterial infections.

Although it's commonly recommended not to use deodorants or antiperspirants, studies haven't shown they make much of a difference.

There is a wide variation in how the condition progresses. It tends to flare up, then improve, rather than get progressively worse.

People with severe cases often aren't adequately treated with medical management. For these people, surgical approaches should be considered. Both surgical removal of skin flaps or "burning" each follicle with a laser have been shown to be safe and effective. The obvious downside is that it does nothing for untreated areas.

In the future, please try to ask your doctor basic questions as soon as you're told about a medical condition. In this case, you may want to consult a dermatologist if your condition gets worse.

Q. I recently was diagnosed with sarcoidosis and can find little information about it. I find the side effects of prednisone to be as much a problem as the disease itself. Any information would be appreciated.

A. Sarcoidosis is one of the more perplexing diseases. Symptoms usually begin between ages 20 and 40, and the disorder is most common among Northern Europeans and African-Americans.

Sarcoidosis is a chronic and systemic disease in which inflammatory cells, fibrous tissue and blood vessels come together to form masses--called granulomas--in many body organs. The cause is unknown but results from an abnormal response of the immune system.

These granulomas either eventually disappear or become scar tissue, which can affect the function of the involved organ. Almost everyone has involvement of the lungs, which can cause a decrease in lung volume and function. Other organs that can be involved include the nervous system, skin, joints, eyes, spleen, liver, lymph glands and sometimes the heart.

Fatigue is a major symptom for people with sarcoidosis. Other complaints include general discomfort, fever and difficulty breathing, but many with sarcoidosis have no symptoms.

The outlook is good for those in the early stages of the disease, but 20 percent of those with lung involvement will get irreversible lung impairment. While it can be fatal in rare instances, it often goes into remission on its own.

Many people with sarcoidosis don't need treatment, but when they do, it's often in the form of long-term oral steroid therapy, often over months and years. Because of the potential association with the immune system, much research is focusing on discovering immunotherapeutic agents.

It's important that you and your doctor monitor your condition closely, both for the progress of the disease and for side effects of the prednisone to determine how much prednisone is the optimum amount for you.

