I have recently undergone surgery for hidradenitis suppurativa. Unfortunately, I have had a recurrence of the problem. Is there a way to prevent continued outbreaks?

Hidradenitis suppurativa is primarily a disease of occlusion (obstruction) and inflammation of the apocrine (odor) sweat glands of the groin and axilla (armpit). It is similar to acne, which is a disease of the sebaceous (oil) glands in the skin. Hidradenitis develops when ducts from the apocrine glands to the skin surface become blocked, leading to a red swollen area on the skin and to the formation of cysts, infection and scarring.

The cause of this uncommon, chronic, recurrent infection, which is slightly more common in African-Americans and women, is unknown. It is not contagious, usually starts during puberty, and sometimes improves during pregnancy. Heredity probably plays some role, with severity varying from person to person. Treatment consists mainly of speeding the healing of the lesions and lessening the severity of an outbreak.

Hidradenitis usually starts as one or more red, tender swellings in the groin or axilla. Over a period of hours to days the lesions enlarge and often open to the skin surface draining clear to yellow fluid. The involved area then heals with scarring. The condition usually continues for years with periods of flare and remission. Sometimes, as in your case, surgery is required to drain infected abscesses or to remove scarred tissue or even large areas of involved skin.

Hidradenitis is made worse by being overweight, but it is not caused by obesity, nor is it caused by poor hygiene. The condition may become worse under stress and is more common in people with diabetes.

Topical antibiotics (applied to the skin) are the treatment of choice. Systemic (by mouth) antibiotics are sometimes necessary, when the condition is flaring or when an outbreak is particularly bad. Occasionally, cortisone-type drugs or the prescription acne medication Accutane may be helpful.

Liposuction has proven effective for a limited number of patients. Liposuction works by "sucking out" the apocrine glands, along with the subcutaneous fat in the affected areas.

Women tend to get the condition more under the arms, and men around the groins, but there is a great deal of overlap. Since the germs infecting the cysts come from the overlying skin surface, scrupulous skin care is necessary with antibacterial soaps. Warm soaks to the armpits or sitz baths for abscesses forming in the groin area should be started as soon you feel any lump or tenderness in the area. Only non-perfumed deodorants should be used to avoid any allergic skin reaction that will increase the likelihood of infection.

Additional measures that help to reduce the frequency and intensity of hidradenitis include:

· Wearing loose-fitting clothing

· Reducing activity that makes you sweat profusely

· Washing with Tea Tree oil soap may help reduce the burning and itching

· Losing weight.