Hidradenitis suppurativa

Hidradenitis suppurativa is a refractory, chronic inflammatory follicular disorder in the apocrine gland bearing areas of the axillary, inguinal, and inframammary areas,  involving the skin and subcutaneous tissue

-HS is not a primary infectious process but rather inflammatory.

-It is more common in women.

-Areas commonly affected: Axillae, inguinal areas, breasts, inframammary areas,inner thighs, buttocks, perianal, perineal regions

-HS is most common in the axilla and inguinal area

-Perineal disease is more common in males, whereas axillary disease is more common in females.

-Risk factors: Obesity, smoking, and tight-fitting clothing.


Symptoms & Signs

Patients typically report a gradual onset of persistent or recurrent boil-like lesions in the axillae and/or inguinal area.



The diagnosis is made clinically

Stage one: Single or multiple abscesses or nodules

Stage two: Nonconfluent, recurrent abscesses, or nodules with sinus tracts and scars.

Stage three: Similar to stage two, but lesions are diffuse and affect an entire region.


General measures: Smoking cessation, weight loss if overweight, and avoidance of tight-fitting clothes

Stage one: Topical clindamycin, oral antibiotics

Stage two: Stage one therapies, intralesional corticosteroids, oral retinoids (acitretin, isotretinoin, alitretinoin);Hormones (Cyproterone acetate, oral contraceptives), incision and drainage, surgical procedures

Stage three: infliximab, Adalimumab, Extensive excision of the affected area, laser therapy


HS can end as large abscesses and fistulas. Other complications include strictures, contractures, depression, suicide, arthritis, squamous cell carcinoma

Q: What is the most common presentation of HS? painful, tender, firm, nodular lesions in axillae

Q: Who is the typical patient of HS? Obese, postpubertal female.

Q: What is the most common site of HS? Axilla

Pilonidal disease

-Pilonidal disease occurs when hair becomes entrapped within a cyst in the sacrococcygeal region

-It is a common condition of the skin and subcutaneous tissue at or near the upper part of the natal cleft of the buttocks.

-It  almost always occur in the midline but can have sinus tracts extending off the midline.

-It is typically chronic with recurrent drainage and inflammation,

-It is more common in teenage and young adult males.

-It is three times more common in men than in women.

-Risk factors: Deep natal cleft, obesity, increased hair density between the buttocks

Symptoms & Signs:

red, fluctuant, tender abscess in the gluteal cleft


History and Clinical examination is sufficient to diagnose this condition

Treatment: incision and drainage; Wound care

Prognosis: Excellent 

Q: What is the most common site of PD? Natal Cleft

Q: Describe the typical patient with PD? Teenager or young adult male