Hidradenitis Suppurativa

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

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Basics

Description

  • 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

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)

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

Prevalence
0.3–4% (1)

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.

Genetics
  • Familiar 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, oral contraceptive pills (OCPs)
  • 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
  • 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)

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Citation

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hidradenitis Suppurativa ID - 116278 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116278/all/Hidradenitis_Suppurativa PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -