WHAT ARE THESE PAINFUL BUMPS IN MY ARMPIT?
Recently, a good friend told me he had developed some painful bumps in his armpit. They were bothering him so much that he went to an urgent care clinic to find out what they were and get something to take for them. Astonishingly, whoever he saw told him he didn’t know what he had and suggested he see a dermatologist. Oh, my goodness! What has happened to medical education? Any “doctor” worth the fee he charges should know there are very few things that cause what my friend had.
The two most likely possibilities that come to my mind are swollen, inflamed, or infected, axillary (the underarm) lymph nodes and Hidradenitis suppurativa. Yes, Hidradenitis suppurativa. If you translate this term from the Latin into English, the “roots” mean the following:
Hidr—means sweat/water
Aden—means gland
Itis—means inflammation
Suppurativa—means the infection is producing pus-containing drainage
So, literally, it means sweat glands are inflamed and the infection is producing pus. Hidradenitis suppurativa is abbreviated HS so henceforth I will use the abbreviation instead.
HS is primarily an adult illness that is 3 times more common in women and is seen in Blacks more often than other races. The bodily areas affected most are the armpits (axillae), groin, buttocks, and under pendulous breasts. These are areas of the body where the skin rubs against itself, especially in obese patients. Cigarette smoking and obesity are factors that increase the chances of HS developing.
The actual cause of HS is unknown, but it is known that it is not caused by poor hygeine or infection, and is not contagious. There is recent evidence to suggest HS is an autoimmune disease. It starts when hair follicles in the affected area become blocked. Hair follicles in the underarm are surrounded by sweat glands, and they become blocked as well affecting the release of perspiration. Plugged hair follicles and sweat glands swell, form blackheads and cysts, and can become infected and develop into blood-and-pus-filled, painful lumps. If the lumps don’t open and drain on their own, they become painful enough that a patient seeks medical attention. That usually results in the lumps being drained. That reduces the pain but not the lump or the swelling around it.
HS often “heals” by forming “rope-like scars” and leaves the affected area pitted and thickened (see the picture above). It can cause tightness of the skin causing limited or painful movement of the armpit. Because the four classic signs of infection (rubor, tubor, calor, dolor—redness, swelling, warmth, pain) are present in HS, it’s natural to think this is a bacterial infection. It doesn’t start out that way, but it becomes infected when the sweat glands and hair follicles remain blocked. When sweat and sebum (skin oil) remain stagnant, bacteria accumulate, multiply, and cause infection, like pond water that accumulates algae on the surface.
Because blackheads, pimples, pustules, and abscesses are all possible with HS, it is occasionally misdiagnosed as folliculitis or acne. In fact, HS was originally called Acne Inversa. But the difference comes when the diseases are treated. Folliculitis and acne get better, HS does not. It is incurable, and until recently, when monoclonal antibody drugs were prescribed, it did not respond to treatment. Oral and topical antibiotics and cortisone injections into the bumps (lesions) help to suppress flare-ups and acute infection, but do not cure the problem. Monoclonal antibody drugs, Remicade and Humira, are FDA approved for HS and are effective by “altering the immune system and disrupting the disease cycle and improving signs and symptoms of the disease within weeks.”
In recent weeks, I’ve seen ads for Cosentyx, another monoclonal antibody drug, that has reported excellent results when prescribed for HS. Patients have had a “50% reduction in the number of inflammatory bumps and abscesses” and “75% of adults had no flare-ups over a 16-week period.” The manufacturer, Novartis, has hit the advertising airwaves pretty heavily in hopes of increasing their bottom line, but if Cosentyx works, it will be a real blessing to the millions of sufferers of Hidradenitis Suppurativa.
Hidradenitis suppurativa is another clear example the value of knowing Greek and Latin derivatives. However, to someone with the disease, that means nothing. The chronicity of HS
makes it a serious problem that patients fight for years. Anything that suppresses it or eliminates it is a welcome happenstance. I had a few patients who had HS. They hated it and nothing I did back then did any good. I went so far as to refer patients to a plastic surgeon, but they were reluctant to do surgery fearing the outcome would be worse than the disease. We must hope that medical researchers are on to something with monoclonal antibody drugs, and that they are the answer.
References: www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa
