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Review
. 2017 Feb;63(2):114-120.

What is hidradenitis suppurativa?

Erika Yue Lee  1 , Raed Alhusayen  2 , Perla Lansang  3 , Neil Shear  4 , Jensen Yeung  5
Affiliations
Review

What is hidradenitis suppurativa?

Erika Yue Lee et al. Can Fam Physician. 2017 Feb.

Abstract

Objective: To provide family physicians with an understanding of the epidemiology, clinical features, diagnosis, and management of hidradenitis suppurativa (HS).

Sources of information: A PubMed literature search was performed using the MeSH term hidradenitis suppurativa.

Main message: Hidradenitis suppurativa is a chronic, recurrent, and debilitating skin condition. It is an inflammatory disorder of the follicular epithelium, but secondary bacterial infection can often occur. The diagnosis is made clinically based on typical lesions (nodules, abscesses, sinus tracts), locations (skin folds), and nature of relapses and chronicity. Multiple comorbidities are associated with HS, including obesity, metabolic syndrome, inflammatory bowel disease, and spondyloarthropathy. Although the lack of curative therapy and the recurrent nature makes HS treatment challenging, there are effective symptomatic management options.

Conclusion: Family physicians should be suspicious of HS in patients presenting with recurrent skin abscesses at the skin folds. Family physicians play an important role in early diagnosis, initiation of treatment, and referral to a dermatologist before HS progresses to debilitating end-stage disease.

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Figures

Figure 1.
Figure 1.
Primary sites of hidradenitis suppurativa involvement. A and B) Axillae: multiple interconnected sinus tracts and abscesses across the entire area bilaterally, consistent with Hurley stage III. C) Genital area: a single abscess with sinus tract in the fold between pubis and penis, consistent with Hurley stage II. D and E) Inguinal folds: diffuse interconnected sinus tracts across the entire area with severe scarring bilaterally, consistent with Hurley stage III.
Figure 2.
Figure 2.
Other common locations of hidradenitis suppurativa. A) Nape of the neck: several abscesses without sinus tracts or scarring, consistent with Hurley stage I. B) Back: multiple inflammatory nodules and comedones with minimal scarring, consistent with Hurley stage I. C) Chest: several painful inflammatory nodules and abscesses with sinus tracts, consistent with Hurley stage II. D) Waistband area: multiple interconnected sinus tracts across the entire area exacerbated by friction, consistent with Hurley stage III.
Figure 3.
Figure 3.
A pilonidal cyst above the gluteal cleft, depicting a component of the follicular occlusion tetrad
See this image and copyright information in PMC

Comment in

References

    1. Jemec GB. Clinical practice. Hidradenitis suppurativa. N Engl J Med. 2012;366(2):158–64. - PubMed
    1. Sellheyer K, Krahl D. “Hidradenitis suppurativa” is acne inversa! An appeal to (finally) abandon a misnomer. Int J Dermatol. 2005;44(7):535–40. - PubMed
    1. Alikhan A, Lynch PJ, Eisen DB. Hidradenitis suppurativa: a comprehensive review. J Am Acad Dermatol. 2009;60(4):539–61. - PubMed
    1. Mebazaa A, Ben Hadid R, Cheikh Rouhou R, Trojjet S, El Euch D, Mokni M, et al. Hidradenitis suppurativa: a disease with male predominance in Tunisia. Acta Dermatovenerol Alp Pannonica Adriat. 2009;18(4):165–72. - PubMed
    1. Matusiak Ł, Bieniek A, Szepietowski JC. Hidradenitis suppurativa markedly decreases quality of life and professional activity. J Am Acad Dermatol. 2010;62(4):706–8. 708.e1. - PubMed

MeSH terms