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