Hidradenitis suppurativa

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 4 main categories: antibiotics, anti-inflammatory medications, hormonal agents, and systemic retinoids. Longer courses of antibiotics are often necessary in order to be effective.

Incision and drainage alone will invariably lead to disease recurrence.

Can lead to significant morbidity with development of scarring, chronic pain, lymphedema, and social stigma. Uncontrolled disease can be complicated by sepsis and transformation to cutaneous squamous cell carcinoma.

Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis that primarily affects intertriginous areas (axilla, groin, perineum, and inframammary 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 likely to be around hair follicles with sweat gland involvement being a secondary event. It is a member of the "follicular occlusion tetrad" of nodulocystic acne, dissecting cellulitis of the scalp, pilonidal cysts, and HS. The disease manifests clinically as inflammatory papules, nodules, and abscesses that can lead to 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.