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
Other diagnostic factors
- premenstrual flare
Risk factors
- obesity
- female sex
- smoking
- positive family history
- African-American
Diagnostic tests
Tests to consider
- bacterial culture
- skin biopsy
Treatment algorithm
acute abscess
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
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.
Differentials
- Acne vulgaris
- Crohn disease
- Inverse psoriasis
More DifferentialsGuidelines
- 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 GuidelinesLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer