RISK FACTORS: Obesity, African American, Female, Acne, Diabetes mellitus, Hypercholesterolemia, Low basal metabolic rate, Smoking possibly,
GENERAL MEASURES:
. Symptomatic treatment acute lesions
. Prevent new lesions
. Local cleansing (germicidal soap)
. Improve environmental factors that cause follicular blockage
SURGICAL MEASURES
. Wide excision with healing by granulation (considered more efficacious than drug treatment); but medical
treatment tried fi rst because of extensive nature of surgical treatment
. Incision and drainage of lesions
. Remove sinus tracts
. Exteriorization with curettage and electrodesiccation
. Treatment for severe, intractable cases: excision and skin graft
. CO2 laser stripping with healing by secondary intention
PATIENT EDUCATION
β’ Minimize heat exposure and sweating
β’ Reduce weight if obese
β’ Avoid constrictive clothing
β’ Medication precautions
DRUG(S) OF CHOICE
. Antibiotics (not curative, relapse almost always inevitable); treatment sometimes for 2 or more months:
. Clindamycin 2% lotion or neomycin cream topically to control odor. Topical clindamycin as effective as
systemic tetracyclines for stage 1 or 2 disease. Oral clindamycin also effective.
. Tetracycline 250 mg qid or 500 mg tid
. Minocycline (Minocin) 100 mg bid po
. Erythromycin 1-1.5 gm qd po
. Doxycycline 100 mg bid 7-14 days
. Other antibiotics depending on culture
. Consider oral retinoids
. Isotretinoin (Accutane) 40-80 mg/day po for 4 months. No Accutane during pregnancy (highly teratogenic).
Equivocal results, still frequent recurrences.
. Birth control pills (female only), if antibiotic therapy fails. Low-dose progesterone BCPs (e.g., Norinyl, Ortho-
Novum, Enovid).
. Consider steroids
. Injection of lesions with depot-type steroids (e.g., triamcinolone)
. Consider brief course of systemic corticosteroids
. Anti-androgen therapy - controversial
PATIENT MONITORING Revisits monthly, or more often if needed
PREVENTION/AVOIDANCE
β’ Minimize heat exposure and sweating
β’ Lose weight if overweight
β’ Avoid constrictive clothing/frictional trauma
β’ Avoid underarm antiperspirants and deodorants
POSSIBLE COMPLICATIONS
β’ Contracture formation at the sites of lesions
β’ Restricted limb mobility
β’ Squamous cell carcinoma may develop in indolent sinus tracts (usually anogenital)
β’ Disseminated infection septicemia- unusual
β’ Lymphedema
β’ Urethral/rectal fi stula
β’ Anemia
β’ Arthritis (asymmetrical pauciarticular to symmetrical polyarthritis/polyarthralgia. Typically larger joints of upper or lower extremities, particularly the knee)
β’ Amyloidosis
β’ Renal failure
β’ Interstitial keratitis
EXPECTED COURSE/PROGNOSIS
β’ Individual lesions (with or without drainage) heal slowly in 10-30 days
β’ Recurrences may last for several years
β’ Rare spontaneous resolution
β’ Relentlessly progressive scarring and sinus tracts