Hidradenitis Suppurativa
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.
- 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(s) affected: skin, psychosocial
- Synonym(s): acne inversa; Verneuil disease; apocrinitis; hidradenitis axillaris
Epidemiology
- Predominant sex: female > male (3:1)
- African Americans
Incidence
Peak onset during 2nd and 3rd decades of life but can be found from puberty until age 40 years
Prevalence
1–4% (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.
- 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)
- Inflammatory bowel disease
- Squamous cell carcinoma
- PAPASH syndrome (pyogenic arthritis, pyoderma gangrenosum, acne, and suppurative hydradenitis)
- Type 2 diabetes mellitus
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Citation
Domino, Frank J., et al., editors. "Hidradenitis Suppurativa." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116278/all/Hidradenitis_Suppurativa.
Hidradenitis Suppurativa. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116278/all/Hidradenitis_Suppurativa. Accessed October 3, 2024.
Hidradenitis Suppurativa. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116278/all/Hidradenitis_Suppurativa
Hidradenitis Suppurativa [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 October 03]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116278/all/Hidradenitis_Suppurativa.
* Article titles in AMA citation format should be in sentence-case
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T1 - Hidradenitis Suppurativa
ID - 116278
ED - Domino,Frank J,
ED - Baldor,Robert A,
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
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DB - Medicine Central
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