Hidradenitis suppurativa (HS) is a 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 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, lymphedema, and impact on social function.
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 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
- 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
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)
- Acne vulgaris
- Crohn disease
- Inverse psoriasis
- Hidradenitis suppurativa/acne inversa: a practical framework for treatment optimization - systematic review and recommendations from the HS ALLIANCE working group
- Guidelines for the management of hidradenitis suppurativa (acne inversa)
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