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Early disease may be cyclic, corresponding to the secretory activity of the apocrine glands during the progestational phase of the menstrual cycle. Antibiotic treatment, however, seldom provides a cure for this infection. Antibiotic regimens providing activity against anaerobes and facultative anaerobes may produce some response. Simple incision and drainage is not effective. Bhatia and associates 1 recommended that the diagnosis be confirmed by biopsy.

#SCAPPLE SOLID LINES INSTEAD OF DOTTED SKIN#

Abscessed glands may rupture at or below the skin surface, infecting the surrounding tissue and forming fistulae to other apocrine glands. It is commonly a complex polymicrobial infection, having been colonized with bacteria from the skin, vaginal flora, and anorectal area. Hidradenitis suppurativa is a disease process that originates in the apocrine sweat glands, and is initiated by closure of the duct or pore, preventing normal expulsion of the gland contents. Shaving across the delicate skin of the vulvar area, crural fold, or mons could also incite or spread such a process by breaking the skin, thus allowing access of staphylococci into the deeper tissue. Predisposing factors include diabetes or systemic conditions resulting in an underlying decreased immune response. Application of moist heat is recommended until the abscess points, allowing incision and drainage. Carbuncles and furuncles are circumscribed areas of inflammation of the skin and deeper tissues, with furuncles specifically beginning in a hair follicle or follicular gland. Incision and drainage may be required for localized abscesses from these infections. They may be treated with topical or systemic antibiotics, depending on the seriousness of the infection. These infections are generally unimicrobial. Infections of the vulva are commonly due to bacteria that inhabit the skin, causing diseases such as carbuncles, furuncles, pyodermatitis, erysipelas, and impetigo.

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