SKIN SORES

[JADE1977]

I have had skin sores on my breast, buttocks, bikini area, face, thighs and under my arms for 9 years.  They are on both sides of my body in the same area.  This morning my new dermatologists called to discuss my lab results.  He informed me that the lab was able to grow bacteria from the sample he sent from one of my skin sores.  He then stated that they could be caused from a mild staff infection, and that they can be treated with antibiotics.  I would like to know if there are other women in the world with this same kind of skin condition and what the normal treatments are.  I have been to so many doctors for this condition since 1995.  I am very angry and confused as to why no other doctor could find the cause for my very painful sores.  I have been on several medications over the years and had "needle happy" doctors.  I had steroids injections for six months last year.  I then went through a very painful cortisone injection right into one of the sores on my breast last February.  How can it now be so simple?  How could all these other doctors never know the source of this awful shin infection and now this one does?  The scarring from the cortisone injection has left me very embarrassed and humiliated.  I did not realize, nor was I informed that the injection would leave such a scare.  I can’t even feel my breast in that area now.  It has been almost a year and I am scared to try any other treatments.  I am weary about needles and very depressed about my situation.  I try to be intimate with my husband but the growing scar and skin deformity causes me to keep my breast covered during intercourse.  I have spoken to an attorney.  He stated that I had two weeks left to file a Malpractice suit against the doctor who ordered the injection.  I have never been to court.  I don’t want to make anyone mad, but I have suffered due to negligence.  I am a state insurance patient and I feel that this is the reason for the lack of care in the past.  My new dermatologist has stated that he would not have recommended the treatment.  Who do I believe?  I just want to look normal and feel attractive.  I am a 25 year old mother of three that just went through a full hysterectomy last March.  Can you help me?    

Sincerely,

Tina Kirby Milligan

[Alan Rockoff, MD]

I understand your frustration, but I thin you need some clarification.  I am not positive of course, because I haven't examined you, but the condition you seem to be describing is called hidradenitis suppurativa.  This causes boils in just the locations you mentioned.  The cause is not known.  Bacteria play little if any role.  The fact that your most recent doctor found staph germs in one sore very likely means nothing at all.  Treating the germs is worth trying, of course, but I doubt it will help much, much less solve the problem.

Treating hidradenitis often involves injections of cortisone.  Doing so is not malpractice; it is good practice, because it helps the boils at least temporarily, and is far less damaging than surgery.  In fact, injection of cortisone is not damaging at all.  At most it can cause temporary (up to 6 months) dimpling of the skin.  Hidradenitis itself often leaves unsightly scars.  Injections help minimize them.

In other words, the doctors who took care of you were doing the best they could with a difficult condtion.  You are entitled to be frustrated, but your frustration would be better directed at the condition, not the people trying to help you.

My advice is to ask your current doctor whether he or she thinks that the diagnosis I'm writing about is what you have.  Other treatments to consider are the tetracycline family of antibiotics, Accutane, and conceivably, surgery to remove the affected glands, thoiugh most people don't need this.

As to your difficulties with intimacy, you may want to seek counseling.  The scars will not go away, but that doesn't mean you don't need help in dealing with them.

Best.

Dr. Rockoff

[JADE1977]

Dr. Rockoff

Thank you so much for responding.  I went and took a good look at my pay bills.  I noticed that the word Hidradenitits is circled.  However, they never informed me that this was my diagnosis.  I would not have authorized the injection of cortisone if I had known possible side effects.  My breast looks awful and I can not feel the skin in that area.  I had enough to worry about without an extra scar.  I also spent most of the night writing a letter to my attorney.  Below is the full story.  

I am a 25 year old wife and mother of three.

I have had skin sores on my breast, buttocks, bikini area, face, thighs and under my arms for 9 years.  They are on both sides of my body in the same area.  

December 3rd 2001: Gold Skin Care Center diagnosed me with Hidradenitits.  They gave me shots; (2) Kefzol (up to 500 mg), and (1) (4) units of Aristicort/Kenalog (per 10 mg).  They then prescribed Erythromycin solution, Fluocinonide Gel and Cephalexin 500mg tablets.  

January 9th 2002:  Gold Skin Care Center gave me shots; (2) Kefzol (up to 500 mg), and (1) (4) units of Aristicort/Kenalog.  They then told me to continue my prescribed medications.  

February 11th 2002: Gold Skin Care Center gave me shots; (2) Kefzol (up to 500 mg), and drained one of the sores to send a sample to the lab.  They then took a biopsy of the Granuloma Annulare on my feet to make sure my former doctor was correct in his diagnosis.  The Nurse Practitioner stated that it did not look like Granuloma Annulare.   I had a complaint about a sore on my breast.  They then injected Cortisone into the sore.  They stated that it would help with the discomfort.  They prescribed Diflucan for the yeast infections which were side effects from the antibiotic.  

March 2002: I spoke with Pamela C. Gunnell, FNP at my primary care physician’s office.  I told her that Dr. Gold's staff wanted to continue the shots/injections and that they were very painful.  She then looked up all the different treatments for Granuloma Annulare and Hidradenitits.  She wrote them down on paper, and suggested that I discuss them with him at my next visit.

April 9th 2002: I went to Gold Skin Care Center.  I requested to speak with Dr. Gold.  They said he was busy, but I insisted on seeing him.  I had always had to see the Nurse Practitioner and felt the need to speak with the doctor.  I waited for about ten minutes and I could hear a male voice very loud in the hall.  However, I could not hear what he was saying.  When he walked into the room he was hanging up his cellular phone.  He looked very upset.  The phone rung again and he stepped out into the hall.  I could hear him yelling and I felt very uncomfortable.  When he came in the room we spoke for a moment about the skin sores and I handed him the paper Pamela C. Gunnell, FNP had given me to discuss with him.  He got very angry and asked me "who the hell do you think you are"  "you are on TennCare and they will not pay for these treatment"!  I was shocked and very upset.  I told him that I would be more than happy to pay for them.  He told me that I was crazy.  I got down from the table and started to cry.  I told him that I wanted to see another doctor.  When we walked into the hall I asked for my chart.  He stated "you are not getting your chart!  I was very upset and when I tried to get my chart he gripped my arm and shoved me away.  I then ran from the building crying and I fell outside the building.  I was having a panic attack and my husband ran from the car to help me.  I told him what happen and he spoke to some of the other patients coming from the building.  They were just as shock about his behavior.    My husband then went into the building to talk to him and Dr. Gold told him to leave or he would call the police.  I had never met Dr. Gold before April 9th 2002.  I hope to never meet him again.  However, I have had side effects to the cortisone medication the nurse injected into my breast on February 11th 2002.  


January 29th 2003: My new dermatologists called to discuss my lab results.  He informed me that the lab was able to grow bacteria from the sample he sent from one of my skin sores.  He then stated that they can be treated with oral antibiotics.  


I am very angry and confused as to why Dr. Gold’s staff gave me all those very painful shots/injections.  The scarring from the injection on my breast has left me very embarrassed and humiliated.  I did not realize, nor was I informed that the injection would leave such a scar.  I can’t even feel my breast in that area now.  It has been almost a year.  I am very depressed about my situation.  I try to be intimate with my husband but the growing scar and skin deformity causes me to keep my breast covered.  I want to file a Malpractice case against Dr. Gold and his business.  The scarring has spread since the injection on April 9th 2002.  I have suffered due to negligence.  I would not have authorized the injection of cortisone if I known the possible side effects. I am a TennCare patient and I feel that this had a part in Dr. Gold's treatment toward me on April 9th 2002.  My new dermatologist has stated that he would not have recommended the injections.  I took all my medications as prescribed and until April 9th 2002; I trusted the Gold Skin Care Center.  Below is information on my condition and the treatment methods.  I want Dr. Gold to pay for re-constructive surgery; any further treatment pertaining to my condition; attorney fees; the emotional trauma this whole ordeal has caused me and my husband.  I also want a formal apology for his behavior on April 9th 2002.   I want to make sure Dr. Gold does not hurt people in the future.  I have copies of my pay bill for each visit.  It lists the treatment and the cost.  I also have the names and phone numbers for the individuals who witness the ordeal on April 9th 2002.  I have been seeing a licensed counselor and psychologist since 2001 for depression and PTSD.  They have documented the emotional effects and my emotional state on that date.  I suffer from PTSD due to childhood physical/sexual trauma and rape.  In March 2002 I also under went a full Hysterectomy due to endometriosis.  I am not trying to financial hurt Dr. Gold or any of the staff at Gold Skin Care Clinic.  However, I do feel they should be responsible for not giving me the proper information on the medication they injected into my breast.  He was very unprofessional and his actions on April 9th 2002 caused a great deal of mental stress.  
      
Sincerely,

JADE


Hidradenitits
  
I. Definition:
Hidradenitits is a chronic disease of the scent or apocrine glands which causes chronic scarring and pus formation of the axillae and groin areas. It is similar to acne which is a disease of the sebaceous glands. This condition is slightly more common in African-Americans and women. Hidradenitits usually starts as one or more red, tender, swellings in the groin or axilla. Over a period of hours to days the lesions enlarge and often open to the skin surface draining clear to yellow fluid. The involved area then heals with scarring. The condition usually continues for years with periods of flare and remission.

II. Causes and Associations:
•For unknown reasons, people with Hidradenitits develop plugging or clogging of their apocrine glands. This leads to bacterial infection which can produce pain and odor.
•Hidradenitits is made worse by being overweight, however this condition is not caused by obesity.
•Hidradenitits is more common in people who have had acne.
•Hidradenitits may become worse under stress.
•Hidradenitits is not caused by poor hygiene.

III. Treatment:
•Topical antibiotics (applied to the skin) are the treatment of choice. Systemic (by mouth) antibiotics are at times necessary when the condition is flaring or when a patient has a severe case.
•Tight-fitting clothing is to be strictly avoided.
•Dirt does not cause Hidradenitits. The involved areas should be cleaned daily using an antibacterial soap, such as the liquid form of Lever 2000. Some patients have found that the liquid form of Lever 2000, applied to the involved areas as a lotion after bathing, can help reduce the odor associated with this condition.
•There is no medical cure for Hidradenitits. Hidradenitits can be controlled, but not cured. Sometimes surgery is required to drain infected areas or to remove scarred tissue or even large areas of skin.
•Weight loss will improve but not cure Hidradenitits.
  

[Alan Rockoff, MD]

Thank you.

I repeat: cortisone injections are the appropriate treatment for hidradentis.  The condition causes scarring, not the injection.  I advise you to show my responses to your attorney.  I also advise you to turn your attention to your condition, not to your anger.

Dr. Rockoff

[MGinAZ]

I am a 31 year old woman and I too have these awful sores.  I remember the first one when I was 16 or 17 years old.
They have become worse as the years have gone by...I thought it was a weight issue since I have gained about 50 pounds since high school and having 3 children.

I have been to 2 different dermatologists who just suggested I use an antibacterial soap.  I was very glad to hear that there is a name for this.  I will be checking with a dermatologist to start treatment.

I have noticed that I get them mainly on my breasts and mostly on areas of my bra seams.  In the past several years I have had to wear a bra day and night because of nursing babies (breast milk leakage).

I have a question about another skin problem:

I have lots of small skin colored bumps all over my hands.  I started noticing them when I was in my 20s.  They don't itch.  They are pretty small, but the there are a couple of larger ones that are raised.  Do you have any idea what this could be?  A DR told me once that it is "early aging spots" and I have heard that it could be a viral wart thing.  What do you think?  Thank you in advance for any information you can give me!

MG

[Corkey1737]

I am a 40 year old woman, who has been living with what seems to be skin sores.  They are red in color and start out looking like an ant bite (white puss head) I get them on my arms, stomach, under my arms, legs and the worst place of all is my buttocks.  There on the buttocks are the worse and most painful; not to mention most embarrasing.  I also have on my right leg (right above the knee) a ring of bumps under the skin and the bumps are raised up just a little.  I have not gone to the dr as of yet for the ring of bumps on my leg but do have an appt next week.  These sores are also on my lower back - as if it is spreading upwards from my buttocks.  I have a very red itchy area at the top part of my buttocks.  I have been told my a dermatologist that my skin is irrritated by laundry detergent and have since tried everything and the sores still persist.  I do notice the red bumps occur on my body where there is restriction, such as the bra on my sides under my arms and around my waist where my panties are.  I am overweight would this have anything to do with it?  Any advise on what this is and what I can do to clear it up - I am so tired of living with it.  Is this contagious to other people?  Is it in my diet that is causing this problem?   What caused it - and why have I had it for six years or so?  Thank you for your time and information on this.

[chubbs]

HI
IAM A DIBETIC TYPE 2 AND I HAVE SORES ON MY STOMACH BUTTOCKS BACK ARMS AND SCALP WENT TO A DERMT.DR AND HE SAID IT WAS CAUSED FROM MY NERVES BUT I THINK IT MIGHT BE FROM THE DIABETIES THEY ARE LIKE A PIMPLE AND THEY ITCH AND HARD TO HEAL UP I SCRATCH THEM AND HELP IT I HAVE TRIED SOME KINDA STINKY STUFF THEY GIVE ME BUT IT DOESNT WORK THEY GET REALLY SORE AND LEAVE VERY NASTY SCARS

CAN U PLEASE HELP ME IN TRYING TO GET RID OF THEM
JUST WISH I KEW WHAT CAUSES THEM
THANKS
CHUBBS

[Vocalmachine]

My niece just started getting these sores on her legs.They have just been coming 2 or 3 at a time.This has been going on for about 4 or 5 weeks now.She is only 3 and she picks the sores and we have a hard time getting her to not pick.She now has scars all over her legs and now she has a few sores on her arms and scars as well.Could this be invitigo or something that just keeps spreading and leaving scars?Her little legs just look awful and the mother is very hard to convince that something needs to be done..What can I do