Published: September 02, 2009 09:07 am      

Lowered immune systems may be susceptible to skin infections

DEAR DR. MONA: I have boils between my legs and in my armpits. Diabetes runs in my family and someone said this could be because of diabetes. How much should I worry about this? — Anna

DEAR ANNA: Boils may be found on the face, breasts, neck, in the armpits, between the thighs, and the buttocks.

Skin infections with the bacteria, Staphylococcus aureus, between the legs is not uncommon. The bacteria may travel on the hair shaft to the follicle and result in inflammation. Your immune system then mounts a protective reaction — the white blood cells attack the bacteria and thus you see white or yellow pus formation which is a combination of dead white cells, bacteria, and dead skin.

Healthy individuals are at risk for formation of boils, but those with lowered immune systems, such as diabetics, seem to have a greater tendency to form boils. So, it is very important if you have recurrent infections to be screened for diabetes.

It is important to ensure that you do not have a condition called hidradenitus supperativa (HS). This is a condition in which the sweat glands become inflamed and the skin starts to ooze and fall apart. HS is commonly found in areas with skin-to-skin contact, such as armpits, groin, thighs, and under breasts and around hair follicles where sweat glands are located.

Characteristically, it progresses from boils or abscesses to hard lumps and painful, rounded, deep-seated inflamed lesions which may seep and result in some scarring. These hard lumps occur under the skin and may grow as large as baseballs. In many cases, they are very painful and may persist for years with or without recurrent inflammation. Inflamed lumps may lead to extensive drainage, which may cause the development of sinus tracts under the skin. These may heal slowly or not at all, leading to further inflammation and lumps. Bacterial infections are possible at these sites as well.

Draining the lumps may provide some pain relief, but the lumps and tracts often recur. HS can be extremely painful and the drainage may have a foul odor. Sufferers often limit their activities, declining to work or even going out in public. As a result, HS sufferers often suffer from depression as well.

HS is often associated with several other conditions including polycystic ovarian syndrome (PCOS), insulin resistance, diabetes, Crohns disease, anemia, hyperhidrosis, acne, and pilonidal cysts.

I would suggest that you see your doctor and find an answer to this condition.

DEAR DR. MONA: I have a lot of cramping and diarrhea when I am under stress. I was told I have a nervous stomach. Is there such a thing? And what do I need to do for that? — Amanda

DEAR AMANDA: There is nothing called nervous stomach. This may be a “waste basket diagnosis” used when an exact answer to your symptoms cannot be found.

I talked with Mohammed Irshad, MD, a Clinton gastroenterologist, who suggested that this could be irritable bowel syndrome, although it could be other things as well.

Irritable bowel syndrome (IBS) is a condition where the walls of the intestine are irritated and contracting irregularly to force the food through the intestine quickly; you may then experience flatulence, bloating and diarrhea.

In other instances, the passage of the food may be delayed and constipation may occur. It has been suggested that those with irritable bowel syndrome have an altered nerve supply that controls the bowel rhythm. This nerve supply change seems to result in more pain when the intestine is stretched. In addition, it may affect the colon and it is thought that since women are more prone to this condition than men, hormones may play a role in this process, since women tend to have more symptoms around the menstrual cycle.

Irritable bowel episodes are triggered by infections such as gastroenteritis, stress, and certain foods such as chocolate, milk, alcohol, carbonated beverages and some fruits. Sometimes food allergies or intolerance may lead to similar symptoms, as with lactose intolerance from dairy products, or allergy to caffeine and the artificial sweetener sorbitol.

So talking with your doctor to get more specific information about test results that led to the “nervous stomach” diagnosis or seeing a gastroenterologist would be a good idea if you continue to be bothered by this problem.



Dr. Mona Alqulali is a board certified OB-GYN.