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Skin Care and Diseases

CYSTS EVERYWHERE

04/27/2005

Question:

HELLO, I AM A 5.9` 300lb 32 YEAR OLD AFRICAN AMERICAN FEMALE WHO OFTEN SUFFERS FROM CYSTS ON MY CALFS, UNDERARMS, GROIN, BREASTS, AND STOMACH. LATELY I`VE BEEN HAVING THEM UNDER MY ARMS AND A CASE OF WHAT SEEMS TO BE ACNE ALL AROUND MY RIGHT ARMPIT HAIRLINE. WHEN I WAS PREGNANT I REALLY GOT THEM BAD ON MY CALFS, BUTTOCKS AND A FEW ON MY BREASTS. WHEN I DID GO TO THE DERMATOLOGIST AND EVEN THE EMERGENCY ROOM, THEY BOTH TOLD ME THAT I AM A PERSON WHO CARRIES ALOT OF BACTERIA IN MY BODY. I DON`T REALLY UNDERSTAND THAT. I`VE BEEN USING ANTIBACTERIAL SOAP FOR YEARS AND IT DOESN`T SEEM TO WORK. IS THERE ANYTHING ELSE I CAN DO BESIDES USE THAT SOAP AND TAKE A SHOWER 2-4 TIMES A DAY. I DON`T HAVE TIME TO TAKE THAT MANY SHOWERS IN A DAY. AND SHOULD I HAVE THE CYSTS UNDER MY ARM LOOKED AT BECAUSE THEY JUST KEEP COMING AND SO DOES THE ACNE. I EVEN PUT MEDICATED POWDER UNDER THERE TO SPEED UP THE PROCESS. SO PLEASE GIVE ME SOME MORE ADVICE BESIDES SEE A DERMATOLOGIST.

Answer:

With the exception of cysts on your legs, your description of abscesses in your armpit and groin suggests that you have the entity known as hidradenitis suppurativa.  This entity is a disease of apocrine sweat glands, is often familial, may be endocrine-based; but as you have indicated a very incapacitating disease.  Until recently the treatment was anti-inflammatory agents, systemic antibiotics, frequent culturing of the pus to be certain that there had not been colonization by both gram positive and gram negative pathogenic bacteria.

Over the last several years, a new group of drugs known as biologics has been introduced.  Most of them have been used for inflammatory diseases such as rheumatoid arthritis and psoriasis; but one of them call Flixamod has been reported to be effective in controlling and, in a few cases, producing long-term remission of the entity hydradenitis suppurativa.

You really should be seen by a more recently-trained, board certified dermatologist who has experience using these drugs.  That individual can tailor medication for you.  Please be aware, however, that they are quite expensive and prior authorization by your insurance carrier will probably be necessary to help you defray the cost.

As indicated above, patients have been treated with antibiotics, incision and drainage; and in some cases the excision of the glans of the groin and axilla, and various ectopic or distant fossi of apocrine glands in various areas of the body.  That is not only painful and disfiguring but also involves an extended period of care while the graft sites heal.  If your dermatologist is reluctant to use one of the biologics, you might consult a plastic surgeon for an opinion on treatment.

Good luck in your search for a solution.  Be advised that your process is not from dirt or uncleanliness; rather it is a basic disease process involving the sweat glands.

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Response by:

Charles L Heaton, MD
Professor
College of Medicine
University of Cincinnati