Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder that affects the axillae, groin, buttocks and inframammary folds. These areas are affected because they bear apocrine glands. Apocrine glands secrete sweat and oil and differ from the sweat glands in other areas of the body such as on our arms and legs.

Cause:

The exact cause of HS is not fully understood but is currently considered an autoinflammatory syndrome. An autoimmune response is triggered after follicular occlusion and rupture occurs in these sites. Age of onset is generally in the 2^nd and 3^rd decades of life. It is three times more common in females than males, but males tend to have more severe disease. Genetics, obesity, smoking, diet and hormonal factors seem to play a role. There is a higher incidence in African Americans.

Clinical Features:

HS is characterized by tender (if not painful), red nodules that usually last an average of 1 week. Most commonly affecting the axillae but can affect other sites as above. Based on physical exam, this disease is generally staged (Hurley Stages 1-3).  

Complications:

Complications of HS include permanent scarring, secondary infections, reduced quality of life, psychosocial changes, and chronic pain.

Diagnosis:

HS is primarily diagnosed clinically; however, a biopsy may be used to help exclude other conditions if there are other suggestive features. Other imaging modalities may be used depending on severity and location of disease.

Differential Diagnosis:

Differential diagnosis includes furuncles/carbuncles, pilonidal disease, ruptured epidermal inclusion cyst, lymphadenitis, and Crohn’s.

Treatment:

Patient education is always important, and patients should be made aware that this is not due to poor hygiene or infectious. Weight loss and smoking cessation can be beneficial. Antimicrobial washes, topical antibiotics, oral antibiotics, and treatments targeting hormonal causes are typical first line therapies. Warm compresses, intralesional steroids, and incision and drainage can be used for acute painful lesions. Biologics, oral retinoids and wide local excisions are considered for more severe cases.

Source: https://dermnetnz.org/topics/hidradenitis-suppurativa and UpToDate

Written by Sydnee Eck, PA

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