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- Chronic follicular occlusive disease manifested as recurrent inflammatory nodules, abscesses, sinus tracts, and complex scar formation
- Lesions are tender, malodorous, often with exudative drainage.
- Common in intertriginous skin regions: axillae, groin, perianal, perineal, inframammary skin
- System affected: skin
- Synonym(s): acne inversa; Verneuil disease; apocrinitis; hidradenitis axillaris
Rare after menopause
Rarely occurs before puberty; occurrence in children is associated with premature adrenarche.
No Accutane (isotretinoin) or tetracycline treatment during pregnancy. Disease may ease during pregnancy and rebound after parturition.
Predominant sex: female > male (3:1)
Peak onset during 2nd and 3rd decades of life
Etiology and Pathophysiology
- Not fully understood; previously considered a disorder of apocrine glands
- 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.
- Obesity and smoking are major risk factors in disease onset and severity.
- Familiar occurrences suggest single gene transmission (autosomal dominant), but the condition may also be polygenic.
- Estimated 40% of patients have an affected family member.
- Hyperandrogenism, oral contraceptive pills (OCPs)
- Lithium may trigger onset of or exacerbate this condition.
- 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
- Arthritis and spondyloarthritis (seronegative)
- Obesity (with diabetes, atopy, acanthosis)
- Irritable bowel disease (Crohn disease)
- Squamous cell carcinoma
- PAPASH syndrome (pyogenic arthritis, pyoderma gangrenosum, acne, suppurative hydradenitis)