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Hidradenitis suppurativa

Last reviewed: 3 Apr 2025
Last updated: 07 Jan 2022

Summary

Definition

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
Full details

Other diagnostic factors

  • premenstrual flare
Full details

Risk factors

  • obesity
  • female sex
  • smoking
  • positive family history
  • African-American
Full details

Diagnostic tests

Tests to consider

  • bacterial culture
  • skin biopsy
Full details

Treatment algorithm

ACUTE

acute abscess

ONGOING

mild (Hurley stage I)

moderate (Hurley stage II)

severe (Hurley stage III)

Contributors

Authors

David Cassarino, MD, PhD

Consultant Dermatopathologist

Southern California Permanente Medical Group

Los Angeles Medical Center

Los Angeles

CA

Disclosures

DC declares that he has no competing interests.

Acknowledgements

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.

Peer reviewers

David R. Adams, MD, PharmD

Associate Professor of Dermatology

Penn State Hershey Medical Center

Hershey

PA

Disclosures

DRA declares that he has no competing interests.

Ravi Ubriani, MD, FAAD

Assistant Professor of Clinical Dermatology

Columbia University

New York

NY

Disclosures

RU declares that he has no competing interests.

Andrew Carmichael, MB, BS

Consultant Dermatologist

James Cook University Hospital

Middlesbrough

UK

Disclosures

AC declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Kim WB, Sibbald RG, Hu H, et al. Clinical features and patient outcomes of hidradenitis suppurativa: a cross-sectional retrospective study. J Cutan Med Surg. 2016;20:52-57.Full text  Abstract

Martorell A, García-Martínez FJ, Jiménez-Gallo D, et al. An update on hidradenitis suppurativa (part I): epidemiology, clinical aspects, and definition of disease severity. Actas Dermosifiliogr. 2015;106:703-715.Full text  Abstract

Sabat R, Jemec GBE, Matusiak Ł, et al. Hidradenitis suppurativa. Nat Rev Dis Primers. 2020 Mar 12;6(1):18. Abstract

Martorell A, García FJ, Jiménez-Gallo D, et al. Update on hidradenitis suppurativa (part II): treatment. Actas Dermosifiliogr. 2015;106:716-724.Full text  Abstract

Kimball AB, Okun MM, Williams DA, et al. Two phase 3 trials of adalimumab for hidradenitis suppurativa. N Engl J Med. 2016;375:422-34.Full text  Abstract

Ingram JR, Woo PN, Chua SL, et al. Interventions for hidradenitis suppurativa. Cochrane Database Syst Rev. 2015;(10):CD010081.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Hidradenitis suppurativa images
  • Differentials

    • Acne vulgaris
    • Crohn disease
    • Inverse psoriasis
    More Differentials
  • Guidelines

    • 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)
    More Guidelines
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