DocSpot: Boils in armpits

Dear Dr Margaret
I keep getting horrible boils in my armpits. They are really painful, and look awful. I don’t know why, because I’m a very clean person. And I am worried that I will give the infection to someone else. Also, do you think it could be caused by deodorants?

I think it’s quite likely you have a condition called ‘hidradenitis suppurativa’. In fact, if you’ve had boils in your armpit on more than five occasions, it’s almost certain to be hidradenitis. It’s not primarily an infection, so you won’t pass it on to anyone else and you won’t spread it to other parts of your own body by touch.

Read on to find out more about hidradenitis, what you can do about it, and the treatment options.

Dr Margaret thanks hidradenitis expert Dr Jan von der Werth, Consultant Dermatologist at Conquest Hospital Hastings, East Sussex, UK, for his help with this answer.

More about hidradenitis

Hidradenitis is caused by blockage of the hair follicles. Once blocked, the hair follicle becomes inflamed and swells up into a nasty, painful, large boil. Bacteria may move in and make the inflammation worse, but these are the common staphylococci bacteria that many healthy people carry in their noses.

Hidradenitis happens only in the folds of the body - almost always the armpits or groins. The boils don’t always burst; they may just fade away after about a week. Some people have the condition very badly, so that the boils never settle completely.

You shouldn’t be worrying that it is caused by lack of hygiene - this isn’t true. No one knows what the cause is. It runs in some families, so it may be partly genetic in some people. Hormones may be involved, because it is often worse before a woman’s period and improves after the menopause.

What to do

You may have already noticed that the boils tend to be worse if you are stressed, so it makes sense to be as ‘laid back’ as you can. Hidradenitis is more common in smokers, so most experts recommend that you should give up smoking. If you have a flare-up, you may find that a hot bath or applying a hot flannel is helpful.

What about deodorants? I didn’t know the answer to your question about deodorants, so I put it to Dr Jan von der Werth, Consultant Dermatologist at Lincoln County Hospital, who is an expert on hidradenitis. "A few of my patients report that deodorants make it worse, but for most people they don’t cause any problem," he said.

See your doctor. I think it’s important that next time you have a flare-up you see your doctor, to check you really have hidradenitis. If it is very painful, your doctor might give you corticosteroid tablets for 3 or 4 days. Lancing the boil is not a good idea, because it often makes the condition worse. And a short course of antibiotics doesn’t usually help.

Your doctor can refer you to a dermatologist for advice about long-term treatment. Ideally, your GP should try to find a dermatologist who is particularly interested in the condition and knows all the treatment options.

Some treatment options. There are several possibilities, and what works for one person may be useless for someone else. A hormone pill is sometimes used. For some people, a long-term tetracycline-type or erythromycin-type antibiotic is beneficial, even though the basic cause of the condition is not an infection. "We don’t really know why these long-term antibiotics are so helpful in some cases," says Dr von der Werth. "It is probably not simply their anti-bacterial action. They probably have a separate anti-inflammatory action."

The drug acitretin can have an excellent result, but needs very careful thought. The dermatologist would not prescribe it for a woman if there was any possibility that she could become pregnant because it damages the developing fetus.

Surgery is an option if your condition is really severe. The surgeon would aim to get rid of the hair follicles in the area by taking away a large piece of skin and letting it scar as it heals. Another treatment is to destroy the follicles by laser surgery or freezing therapy.

An excellent website on hidradenitis

Because hidradenitis tends to be a long-term problem, you need to become well informed about it. I suggest you look at the excellent website of HIDE, the non-profit-making Hidradenitis Information Development and Exchange at www.hideintl.org/. They chose the name HIDE because that is how so many people with hidradenitis feel. The page looking at ‘What exactly is hidradenitis suppurativa?’ and the ‘Asking the experts’ page are especially good.

Last updated; Friday, April 15th 2011 at 4:48 am

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