Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that primarily involves intertriginous areas (i.e., axilla, groin, perineum, and infra-mammary area).
Treatment is often multidisciplinary. Early referral to an appropriate specialist for discussion of medical and surgical options should be considered.
Medical therapy falls into four main categories: antibiotics, anti-inflammatory medications, hormonal agents, and systemic retinoids. Longer courses of antibiotics are often necessary in order to be effective.
HS is associated with significant morbidity, with development of scarring, chronic pain, lymphoedema, and impact on social function.
HS is a chronic inflammatory dermatosis that primarily affects intertriginous areas (axilla, groin, perineum, and infra-mammary region). While the name and distribution imply that the disease originates in the sweat glands, the pathogenesis is more likely due to involvement of hair follicles, with sweat gland involvement being a secondary event. The disease manifests clinically as inflammatory papules, nodules, and abscesses, and is often associated with scarring. Purulent drainage and sinus tracts can be noted in more advanced disease.
HS is a member of the follicular occlusion tetrad that includes nodulocystic acne, dissecting cellulitis of the scalp, and pilonidal cysts.
History and exam
Key diagnostic factors
- presence of risk factors
- recurrent disease
- poor response to previous antibiotic therapy
- open comedones in intertriginous (axilla, groin, perineum, or infra-mammary) areas
- nodules or abscess
- symmetrical distribution
- sinus tracts with scarring
Other diagnostic factors
- premenstrual flare
- female sex
- positive family history
Investigations to consider
- bacterial culture
- skin biopsy
mild (Hurley stage I)
moderate (Hurley stage II)
severe (Hurley stage III)
David Cassarino, MD, PhD
Southern California Permanente Medical Group
Los Angeles Medical Center
DC declares that he has no competing interests.
Dr David Cassarino would like to gratefully acknowledge Dr Robert A. Lee, the previous contributor to this topic.
RAL declares that he has no competing interests.
David R. Adams, MD, PharmD
Associate Professor of Dermatology
Penn State Hershey Medical Center
DRA declares that he has no competing interests.
Ravi Ubriani, MD, FAAD
Assistant Professor of Clinical Dermatology
RU declares that he has no competing interests.
Andrew Carmichael, MB, BS
James Cook University Hospital
AC declares that he has no competing interests.
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