Verneuil’s disease: photo, cause, treatment, what is it?

Verneuil’s disease is a chronic skin disease that often begins in adolescence or in young adults (slightly more often in women). It will concern less than 1% of the European population according to French Society of Dermatology (SFD). Causes, symptoms, stages, treatments, healing… Interview of the doctor Francine Velly-Mores, dermatologist in Lille, to understand what Verneuil’s disease is.

Definition: what is Verneuil’s disease?

There Verneuil’s disease is a chronic inflammatory disease of the hair follicle also called hidradenitis or hidradenitis suppurativa. It is characterized by the appearance of painful skin nodules and abscesses caused by a inflammation of the sweat glands. Verneuil’s disease progresses through painful flare-ups for several months, even several years, interspersed with periods of remission. The severity of the damage varies from person to person. Verneuil’s disease can have different forms: it is most often moderate and compatible with a normal lifebut it can turn out in a more violent form and cause serious inconvenience in daily and family life.

The difficulty in treating Verneuil’s disease lies precisely in the fact that its causes remain unknown. “Of the family history are described at 30 to 40% of patients affected, reports the SFD. Several genes have been implicated in disease. (…) A hormonal involvement is also suspected (appearance of the disease from puberty in particular).”

Pictures of Verneuil’s disease

What are the symptoms of Verneuil’s disease?

The first manifestations, which most often appear after pubertyare nodules isolated from each other and located under the skin. These nodules become more and more painful and evolve towards suppuration, that is to say a discharge of pus which can leave indelible traces. Of many scars, often unsightly, can then appear. The lesions are observed where the sweat glands exist: under the armpits, on the buttocks, at the level of the armpits, inguinal folds, between the anus and the genitals, under the breasts, on the nape of the neck.

Treatments: can Verneuil’s disease be cured?

The management strategy for Verneuil’s disease is based in the first place on the hygieno-dietetic rules (loss of weight, stopping smoking), management of pain and psychological impact. No treatment can cure it permanently but some can nevertheless help to prevent infectious episodes and relieve pain, thus allowing to live better with this pathology. There High Authority of Health recalled the procedures for the management of Verneuil’s disease in 2021:

• A wash with soap and water must be done as a first intention at the time of a push.
• Of the short-term antibiotics as initial treatment infectious outbreaks (combination amoxicillin-clavulanic acid or pristinamycin), except in the case of fever.
• Antibiotics may also be indicated later and preoperatively.
• In moderate forms (Hurley stage II), the attack treatment during an attack includes, in addition to antibiotic therapy, a incision-drainage for analgesic purposes. A treatment with cyclin or cotrimoxazole can then be initiated (reassessment at 6 months). In the event of a recurrence at the same location, a surgery limited excision will be performed.
• In case of failure observed at reassessment after 3 to 6 months, treatment will include wide excision of the cords and sinuous tracts or marsupialization, and the patient will receive a Hurley stage III treatment (severe forms).
• Humira® (adalimumab) is a treatment of 2^th intention in moderate to severe forms in adults. It can be used as a relay for antibiotic therapy or in combination with it.

• Light therapy: Doctor Francine Velly-Mores indicates that at the healing stage “a possible and complementary treatment by LED light therapy can be carried out in a dermatology office in order to accelerate the healing process of the lesions. The treatment would remain temporary but may limit scarring”.

Are there any foods to avoid when you have Verneuil’s disease?

There is no no specific diet for patients with Verneuil’s disease, but it is nevertheless important to have a balanced diet and to be well hydrated.

What are the stages of Verneuil’s disease?

Verneuil’s disease is classified into so-called “Hurley” stage of severity: ranging from the lightest stage (stage 1) to the most severe (stage 3), 75% of patients are at stage 1, 24% at stage 2 and 1% at stage 3 (this form of the disease then resulting in its classification as a rare disease).

• Stage 1: presence of sensitive and painful subcutaneous nodules
• Stage 2: nodules in strings or even in painful patches, but with intervals of healthy skin
• Stage 3: Diffuse involvement (without intervals of healthy skin) with multiple interconnected abscesses and fistulous tracts that communicate with each other.

Is Verneuil’s disease contagious?

No, Verneuil’s disease is not a contagious or sexually transmitted disease.

When and which specialist to consult?

Verneuil’s disease remains poorly understood. If the patient observes recurrent nodules on his skin accompanied by itching with frequent discharge and all the more so if these lesions appear in the same places (neck, armpits, chest, genital area), it is important to consult a doctor. It can be a doctor in first intention, who will then refer his patient to a dermatologist.

It takes an average of 8 years to make the diagnosis of Verneuil’s disease. because of the ignorance of this disease by the medical community. The diagnosis is based on a clinical skin examination performed by a dermatologist. The 3 criteria retained in favor of a hidradenitis suppurativa are :

1. Painful nodules and abscess progressing to suppurationfistulization and/or scar formation.
2. Typical locations : armpits, inguinal folds, perianal and/or perineal region, breasts and submammary folds, inter-gluteal fold, pubis.
3. Chronic character and recurrent lesions: at least 2 attacks in 6 months.

Of the follicular diseases can precede the first symptoms by several years Verneuil’s disease (pilonidal sinus, dissecting cellulitis of the scalp, acne, conglobata for example). Of the digestive or rheumatic inflammatory pathologies can also be associated (asthenia, weight loss, morning pain/stiffness, peripheral joint swelling, sciaticaheel pain, abdominal pain feverish or not, blood or mucus in the stool…).

Psychological care: avoiding depression

Verneuil’s disease, in its most severe forms, affects the quality of life of patients. During episodes of superinfection, the oozing of the lesions handicaps social life. The fear of staining your clothes as well as the smells linked to the infection are very guilt-inducing and difficult to live with on a daily basis. It is essential to consider psychological care in order to learn how to live better with this disease. Depression can indeed appear, the patient withdrawing into himself, no longer daring to go out, experiencing more and more difficulty in sustaining the gaze of others. Moreover, it is always difficult to accept that no treatment can completely eliminate the disease.

Thanks to Doctor Francine Velly-Mores, dermatologist in Lille. Comments collected in 2019.

Sources:

Treatment of Hidradenitis Suppurativa. SFD. 2019

Verneuil’s disease or hidradenitis suppurativa Dr Michael ATLAN, MCUPH. AP-HP. 2016.