Of hair pulling and excessive sweating
The Manila Times
By DR. GRACE CAROLE F. BELTRAN
© ABS-CBN Interactive 2004
Do you know that pulling hair on your skin can cause great and permanent
damage on the affected area? Hair pulling can cause temporary or permanent
alopecia (balding), hair breakage, split ends, carbuncles or furuncles.
Still many think that having hair growing on their faces, ears, arms and
armpits is worst than these complications.
Before the advent of lasers, the only way to get rid of the unwanted hair is
to pull them out or to shave them. This however leaves the armpit skin very
rough, and the growing stubbles have the texture of a toothbrush bristle.
Very unfeminine!
Pulling them on the other hand without cleansing the armpit pre- and
post-pulling lead to a condition of hidradenitis suppurativa, an undesirable
skin condition where infection occurs due to improper hair pulling. Bacteria
on the skin’s surface travels down the open pores from where hair was pulled
out. The microorganisms proliferate in those entry points, giving rise to
the development of multiple small abscesses (pigsa).
If untreated, these could create tunnels beneath the skin where pus could
travel and eventually spread, creating another opening at the end of that
tunnel, and allow the increasing amount of pus that has accumulated to ooze
out. This becomes an unending process (chronic) wherein the patient treats
the infection through antibiotics, only to have it again in a matter of days
or weeks.
In untreated cases, infection becomes really bad after sometime producing
more gruesome infection over the armpit, which spreads to nearby tissues
producing skin with a ruddier appearance, more swelling and softening and
exuding more pus with a foul, stinking odor. The inevitable is the severe
scar formation that can result from this problem. Multiple indentations and
multiple holes on the skin, redness and nodules (bukol) etc . . . are the
results of this infection.
Recently, a patient came to me with mild hidradenitis with hyperhidrosis or
excessive sweating. She was injected with botulinum toxin for the hands and
feet. She responded adequately with the injections and opted to have
liposuction over both armpits. Liposuction of the armpits with subdermal
curettage using a different gadget reduces by 50 percent to 85 percent
severe sweating over these areas. However, having a history of hidradenitis
makes it more difficult to do liposuction and curettage. Why is this so?
Excessive fibrosis brought about by the scarring after recurrent infection
causes multiple skin dimpling, making the separation of the skin’s third
layer from other structures below extremely difficult. This tight attachment
limits the suctioning of sweat glands in those areas where they should be
suctioned. Failure to suction these areas makes the success of the procedure
for sweat gland removal less favorable. This is the reason sweating may not
decrease as significantly as if that patient did not have these scars at
all.
Having hidradenitis suppurativa is therefore a rate-limiting success factor
for liposuction of the armpit in excessive sweating. Patients should be made
aware of this limitation.
However despite these problems, liposuction with subdermal curettage still
remains one of the best options for a more permanent and effective remedy
for excessive sweating over the armpit.
For comments or suggestions please call 373-1558 or 414-5880, (0917) 497-6262, or e-mail at gc_beltran@yahoo.com