Be prompt in treating hidradenitis suppurativa. (Don't Delay Surgery When Antibiotics Fail).

ST. Louis -- In the past year, Dr. Sebastian Paro has treated a dozen cases of hidradenitis suppurativa, once considered a relatively rare disease.

And when it strikes, if patients don't respond to antibiotic therapy, don't delay surgery Waiting will only result in having to do more extensive, often disfiguring excisions later on, Dr. Faro, an ob.gyn. and infectious disease expert, said at the 11th International Pelvic Reconstructive and Vaginal Surgery Conference.

The etiology of hidradenitis suppurativa is unknown but appears to involve bacterial infection in the apocrine glands and starts as a single inflamed follicle that spreads secondarily through the sinus tracts.

Medical therapy with antibiotics, steroids, and hormones is often ineffective, leaving surgery with wide excision of the affected area as the only reasonably effective therapeutic approach, said Dr. Faro of the University of Texas, Houston.

"It's very important that we do not confuse [hidradenitis suppurativa] with folliculitis," he said. In the early stages, the two conditions look alike, but the treatment approach to each is very different.

The axilla, buttocks, vulva, and groin are where hidradenitis suppurativa lesions are most commonly found. They characteristically appear as twin comedones forming a single follicle, which causes it to form a Y-like split on the surface. Close inspection reveals a triangle of three blackheads, which is key for distinguishing it from folliculitis.

It's not dear if the inflammatory process is prompted by infection, but in any case, the process seals off the apocrine gland, and bacteria in the gland cause an abscess.