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Sunday, May 19, 2013
Skin Care and Diseases
I am a 26 year female, that has had in the last four months a total of 4 boils. The first one was on the right side of my labia and I drained on my own. I went to the doctor and started antibiotic. A month later I got another in the same general area but had move to the front of my labia, that drained on it`s own, but also required antibiotics as well. The 3rd was also on the labia a couple inches away from the last 2. This one was lanced and packed, and I recieved antibiotics as well. They were all with in a month of eachother. I currently have on eon my lower stomache, that is draining, but I have not seen my doctor yet. These are extremly painful, and frankly I worried that there is a bigger underlined problem that is causing me to get them. I never had a boil in my life until 4 months ago. I was diagnosed with fibromyalgia, bipolar disorder and many other issues that go hand in hand with the fibromyalgia. My immune system is low because of my disease, could something else be causing these to reacurr even with many rounds of strong antibiotics? I am desperate to find answers. I am not sure if this might relate to anything, but I have benn sick this winter with the flu,sinus infection, colds, weight gain, and also a bout of h-pylori and bacterial vaganosis. I am in a living hell and having panic attacks because of constant worry. If you can help shed some light for me I will be forever grateful.
There are several things that can cause recurrent "boils" in the vulvar, genital, and mons/abdominal area such as you describe.
Two of the most common things to think of include recurrent "infectious boils" (called folliculitis and furunculosis), often caused by the staphylococcus aureus bacteria but may be caused by other bacteria, and an inflammatory condition of the hair follicle and apocrine gland (called hidradenitis suppurativa). Other rare conditions may include things such as cutaneous (skin) Crohn's disease and some other inflammatory diseases that your dermatologist can try to evaluate for.
Infectious boils (furunculosis) from staph aureus can be treated with warm compresses, incision and drainage, antibacterial washes and/or antibiotics depending on the severity. If you get recurrent boils, this would require confirming the bacteria causing them, finding out which antibiotics the bacteria are sensitive to, and then treating appropriately for the possibility that you are a carrier for the bacteria. Your dermatologist should be able to help you with this.
Hidradenitis suppurativa is a poorly understood disease. It is felt that although bacteria can play a role in aggravating the condition, the primary problem is one of inflammation of the hair follicle and apocrine gland structures. This condition often occurs in the vulvar area, mons (above the vulva/vagina area), groin, buttock, inside of thighs, under breasts, in the underarms and sometimes on the abdomen/belly. This is a chronic, recurrent disorder with periods of flaring and quiescence. As with "infectious" boils (furuncles), warm compresses, incision and drainage, antibacterial washes, topical antibiotics and oral antibiotics are often used. These may be needed on and off for a long period of time depending on the activity of the disease.
For patients with moderate to severe hidradenitis suppurativa, various antibiotics along with anti-inflammatory or immunosuppressive therapies such as isotretinoin (Accutane), thalidomide, dapsone, infliximab, adalimumab, prednisone (or other internal steroids) may be needed. Occasionally, in severe cases, surgical removal of the boils or of the whole area of the glands is needed. Known aggravating factors include stress and obesity (the heavier one is the more potential there is for aggravation of the condition). Poor diet, poor sleep, smoking, certain medications (such as lithium) may also aggravate it although there isn't good proof yet for this. Good control of your weight, stress, bipolar disorder, panic attacks, and fibromyalgia may actually reduce the condition.
It is important for you to see a Board Certified Dermatologist for an accurate diagnosis and appropriate therapy.
Pranav Sheth, MD
College of Medicine
University of Cincinnati