Chronic inflammatory skin disease that primarily involves intertriginous areas (i.e., axilla, groin, perineum, and inframammary 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 4 main categories: antibiotics, anti-inflammatory medications, hormonal agents, and systemic retinoids. Longer courses of antibiotics are often necessary in order to be effective.
Incision and drainage alone will invariably lead to disease recurrence.
Can lead to significant morbidity with development of scarring, chronic pain, lymphedema, and social stigma. Uncontrolled disease can be complicated by sepsis and transformation to cutaneous squamous cell carcinoma.
Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis that primarily affects intertriginous areas (axilla, groin, perineum, and inframammary region). While the name and distribution imply that the disease originates in the sweat glands, the pathogenesis is likely to be around hair follicles with sweat gland involvement being a secondary event. It is a member of the "follicular occlusion tetrad" of nodulocystic acne, dissecting cellulitis of the scalp, pilonidal cysts, and HS. The disease manifests clinically as inflammatory papules, nodules, and abscesses that can lead to scarring. Purulent drainage and sinus tracts can be noted in more advanced disease.
History and exam
- at-risk demographic
- history of acne vulgaris
- recurrent disease
- poor response to previous antibiotic therapy
- open comedones in intertriginous (axilla, groin, perineum, or inframammary) areas
- nodules or abscess
- symmetrical distribution
- sinus tracts with scarring
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 monograph. 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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