Hidradenitis Suppurativa

BASICS

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.
Has higher risk of concomitant decrease in quality of life secondary to physical, emotional, and psychological stress.
Common in intertriginous skin regions: axillae, groin, perianal, perineal, inframammary skin
System affected: skin, psychosocial
Synonym(s): acne inversa; Verneuil disease; apocrinitis; hidradenitis axillaris

Peak onset during 2nd and 3rd decades of life but can be found from puberty until age 40 years

1–4%

Not fully understood; previously considered a disorder of apocrine glands but more recently thought to be due to a follicular epithelium defect.
Pathogenesis is multifactorial with immunologic, hormonal, genetic, and environmental factors playing a role.
The primary events are follicular hyperkeratosis and occlusion of terminal hair follicle.
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.

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

Obesity
Smoking
Hyperandrogenism
Drugs: oral contraceptives, IM medroxyprogesterone acetate, levonorgestrel, lithium

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

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)
Inflammatory bowel disease
Squamous cell carcinoma
PAPASH syndrome (pyogenic arthritis, pyoderma gangrenosum, acne, and suppurative hidradenitis)
Type 2 diabetes mellitus

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