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- Acute, tender, cystlike or nodular subcutaneous abscesses, commonly occurring in the skin of the axillae, perineum, areolae, and inframammary regions (rarely near umbilicus, scalp, trunk, or face)
- Chronic abscess formation with rupture and re-epithelialization causes sinus tracts to develop.
- Common from late puberty through age 40 years.
- System affected: Skin
- Synonym(s): Acne inversa; Verneuil's disease; Apocrinitis; Hidradenitis axillaris
Rare after menopause
Rarely occurs before puberty; occurrence in children associated with premature adrenarche
No isotretinoin (Accutane) or tetracycline treatment during pregnancy. Disease may ease during pregnancy and rebound after parturition.
- Predominant age of onset: 11–40 years
- Predominant sex: 3:1 female-to-male ratio
Peak onset during 2nd and 3rd decades of life
- Lithium may trigger onset, or exacerbate this condition.
- Androgenic progestins in oral contraceptive pills (OCPs) may trigger onset of this condition.
Unknown; some studies suggest single gene transmission (autosomal-dominant), but the condition may also be polygenic.
- Weight loss if overweight or obese.
- Smoking cessation.
- Avoid constrictive clothing/synthetic fabrics, frictional trauma, heat exposure, excessive sweating, shaving, depilation, and deodorants.
- Use antiseptic soaps; apply tea tree oil topically.
- Traditionally considered a disorder of apocrine glands, but now believed to be an inflammatory disorder of the hair follicle triggered by follicular plugging within apocrine gland–bearing skin.
- Lymphohistiocytic and granulomatous inflammation of the terminal hair follicle, sinus tract formation, and scarring
- Bacterial involvement is a secondary event.
- Sebum excretion is not an important factor.
- Smoking is a major factor in disease onset and severity.
- Considered part of follicular occlusive tetrad: Acne conglobata, dissecting cellulitis of scalp, hidradenitis suppurativa, and pilonidal cysts
- A genetic component may exist.
Commonly Associated Conditions
- Acne conglobata (not acne vulgaris)
- Perifolliculitis capitis abscedens et suffodiens (dissecting cellulitis of scalp)
- Pilonidal disease
- Arthritis and spondyloarthritis (seronegative)
- Obesity with associated diabetes mellitus, atopy, or acanthosis nigricans
- Irritable bowel disease (notably Crohn disease)
- Squamous cell carcinoma