Hidradenitis suppurativa

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).[1]Jemec GB. Clinical practice. Hidradenitis suppurativa. N Engl J Med. 2012;366:158-164. http://www.ncbi.nlm.nih.gov/pubmed/22236226?tool=bestpractice.com [2]Lee RA, Yoon A, Kist J. Hidradenitis suppurativa: an update. Adv Dermatol. 2007;23:289-306. http://www.ncbi.nlm.nih.gov/pubmed/18159906?tool=bestpractice.com 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.[3]Jemec GB. Hidradenitis suppurativa. J Cutan Med Surg. 2003;7:47-56. http://www.ncbi.nlm.nih.gov/pubmed/12457209?tool=bestpractice.com 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.