Alright, let's do one last case to review another
important disease that we have not yet mentioned.
This is a 24-year old obese woman with
a past medical history of diabetes,
who is now presenting with acute
on chronic pain in both axillae.
She has intermittently had mild discomfort
in one or both axilla for months to years,
but has noted the development of
multiple, inflammed, red, tender bumps
over the past few weeks that
occasionally rupture and drain.
No fevers or chills.
She smokes a pack a day, denies
any alcohol or illicit drugs.
Her mother, interestingly had similar
issues herself many years ago.
Review of systems is negative and on our exam we see
multiple, deep, nodular lesions in both axillae
that are tender and erythematous.
There's a 2x3 cm lesion that even expresses
some purulent drainage when compressed.
There is scarring present in her left
axilla and a few comodones are noted.
So let's go through some key features of this case to
get us thinking about what the ultimate diagnosis is.
So I can tell you that this disease that I have
not yet identified is more common in women.
It's also more common in those who are obese and
it typically has an onset in late adolescence.
The fact that we have symmetric
symptoms is also characteristic.
Usually the axilla is involved, occassionally patients
will also have lesions in the anogenital region.
The family history is also important.
Oftentimes, patients will report that their mother or
an aunt or some other family member had this disease
but that it spontaneously resolved as that
significant other or family member got older.
So this diagnosis is
This is a chronic suppurative disease of the apocrine
glands and since apocrine glands - that is sweat glands,
are most often occuring in the axilla and the groin,
that's why the disease there is most abundant.
What's happening is follicular occlusion, followed by
follicle rupture which leads to an immune response
and ultimately a superimposed
because of the disruption of the body's
natural immunity around hair follicles.
The treatment is gonna be weight loss, there's
evidence that smoking cessation can also help
and you wanna tell patients to avoid shaving in the area cause
that's just gonna exacerbate the location of the disease.
Using gentle soaps can be helpful.
For significant disease, we can use
oftentimes topical or
occasionally systemic antibiotics
and oftentimes you need refer this patient to a surgeon
for surgical incision and drainage when necessary
if there's a large collection.
Lastly, under extenuating circumstances, we may
use systemic corticosteroids,TNF-alpha inhibitors
or potentially isotretinoin which we've talked
about before with the treatment of acne vulgaris.