Hidradenitis Suppurativa

Hidradenitis Suppurativa is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Chronic inflammatory skin disease manifested as recurrent inflammatory nodules, abscesses, sinus tracts, and complex scar formation
  • Areas affected are tender, malodorous, often with exudative drainage.
  • Common in intertriginous skin regions: axillae, groin, perianal, perineal, inframammary skin
  • System affected: skin, psychosocial
  • Synonym(s): acne inversa; Verneuil disease; apocrinitis; hidradenitis axillaris

Geriatric Considerations
Rare after menopause

Pediatric Considerations
Rarely occurs before puberty; occurrence in children is associated with premature adrenarche.

Pregnancy Considerations
No Accutane (isotretinoin) or tetracycline treatment during pregnancy. Disease may ease during pregnancy and rebound after parturition.

Epidemiology

  • Predominant sex: female > male (3:1)
  • African Americans

Incidence
Peak onset during 2nd and 3rd decades of life

Prevalence
0.05–4.10% (1)

Etiology and Pathophysiology

  • Not fully understood; previously considered a disorder of apocrine glands but more recently thought to be due to a follicular epithelium defect. Deregulation of the local immune system may also play a role.
  • Inflammatory disorder of the hair follicle triggered by follicular plugging within apocrine gland–bearing skin
  • Hormonally induced ductal keratinocyte proliferation leads to a failure of follicular epithelial shedding, causing follicular occlusion.
  • Mechanical stress on skin (intertriginous regions) precipitates follicular rupture and immune response.
  • Bacterial involvement is a secondary event.
  • Rupture and reepithelialization cause sinus tracts to form.

Genetics
  • Familial occurrences suggest single gene transmission (autosomal dominant), but the condition may also be polygenic.
  • Estimated 40% of patients have an affected family member.

Risk Factors

  • Obesity
  • Smoking
  • Hyperandrogenism
  • Lithium may trigger onset of or exacerbate this condition.

General Prevention

  • Lose weight if overweight or obese.
  • Smoking cessation
  • Avoid constrictive clothing/synthetic fabrics, frictional trauma, heat exposure, excessive sweating, shaving, depilation, and deodorants.
  • Use of antiseptic soaps

Commonly Associated Conditions

  • Acne vulgaris, acne conglobate
  • Perifolliculitis capitis abscedens et suffodiens (dissecting cellulitis of scalp)
  • Pilonidal disease
  • Metabolic syndrome/obesity
  • Polycystic ovary syndrome (PCOS) and androgen dysfunction
  • Thyroid disease
  • Arthritis and spondyloarthritis (seronegative)
  • Irritable bowel disease (Crohn disease)
  • Squamous cell carcinoma
  • PAPASH syndrome (pyogenic arthritis, pyoderma gangrenosum, acne, and suppurative hydradenitis)

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