Hidradenitis Suppurativa

Descriptive text is not available for this image 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 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%

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.
  • 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.

Genetics

  • 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.

RISK FACTORS

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

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 hidradenitis)
  • Type 2 diabetes mellitus

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