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Hidradenitis suppurativa

Last reviewed: 2 Oct 2024
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.

  • 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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