4.1.4 Hidradenitis Suppurativa

Synonyms

Acne inversa; pyodermia fistulans sinifica.

Epidemiology

Prevalence 0.03-4% (average 1%), annual age- and sex-adjusted incidence 6.0 per 100,000. Male:female ratio 1:3. 

Definition

Chronic, inflammatory, recurrent, debilitating skin disease (of the terminal hair follicle) usually presenting after puberty with painful, deep-seated, inflamed lesions in the apocrine gland-bearing areas of the body, most commonly the axillary, inguinal, and ano-genital regions.

Aetiology & Pathogenesis

The exact pathogenetic mechanism of hidradenitis suppurativa remains unclear. Smoking, obesity and metabolic syndrome are major predisposing factors.

Signs & Symptoms

Chronic recurrent inflammatory nodules, abscesses, draining tunnels (sinuses, fistulae and double comedones) and scars.

Localisation

Mostly intertriginous occurrence.

Classification

Combination of anatomical classification: Hurley I, II, III and severity classification: mild, moderate, severe.


Syndromic hidradenitis suppurativa diseases.

Laboratory & other workups

C-reactive protein, erythrocyte sedimentation rate. 

Dermatopathology

Heterogeneous histological pattern with hyperplasia of hair follicular epithelium and subepidermal and deep cellular inflammatory infiltrate. 

Course

Acute and chronic. 

Complications

Squamous cell carcinoma in chronic ano-genital lesions, deep scars, depression, unemployment, change of profession.

Diagnosis

Outbreak of boils during the last 6 months with a minimum of 2 boils in one of the following 6 locations: axilla, groin, genitals, buttocks, under the breasts and perianal area, neck and abdomen regions. 

Differential diagnosis

Staphylococcal infection (furuncle, carbuncle), cutaneous Crohn’s disease , primary or metastatic tumors, lymphogranuloma venereum, apocrine abscess.

Prevention & Therapy

Active inflammatory stage


Mild: Topical clindamycin, topical antimicrobials.

Moderate: Oral clindamycin plus rifampicin; tetracycline; adalimumab; acitretin.

Severe: Adalimumab +/- clindamycin/doxycycline.


Chronic including inactive (non-inflammatory) stage.


Local or wide excision.

 

Prevention


Weight loss and tobacco abstinence, pain management, treatment of secondary infections.

Special

Comorbid disorders: Inflammatory bowel disease, spondylarthropathy, increased cardiovascular risk.


Syndromic hidradenitis suppurativa diseases are rare.

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