Hidradenitis suppurativa

Author: Vanessa Ngan, staff writer and Dr Amanda Oakley, Dermatologist in 1997. Updated December 2015.

What is hidradenitis suppurativa?

Hidradenitis suppurativa is an inflammatory skin disease that affects apocrine gland-bearing skin in the axillae, in the groin, and under the breasts. It is characterised by recurrent boil-like nodules and abscesses that culminate in pus-like discharge, difficult-to-heal open wounds (sinuses) and scarring.

The term hidradenitis implies it starts as an inflammatory disorder of sweat glands, which is now known to be incorrect. Hidradenitis suppurativa is also known as acne inversa.

Who gets hidradenitis suppurativa?

Hidradenitis often starts at puberty, and is most active between the ages of 20 and 40 years, and in women, can resolve at menopause. It is 3 times more common in females than in males. Risk factors include:

* PAPA syndrome (Pyogenic Arthritis, Pyoderma gangrenosum and Acne), PASH syndrome (Pyoderma gangrenosum, Acne, Suppurative Hidradenitis) and PAPASH syndrome (Pyogenic Arthritis, Pyoderma gangrenosum, Acne, Suppurative Hidradenitis)

What causes hidradenitis suppurativa?

Hidradenitis suppurativa is an autoinflammatory disorder. Although the exact cause is not yet understood, contributing factors include:

What are the clinical features of hidradenitis suppurativa?

Hidradenitis can affect a single or multiple areas in the armpits, neck, submammary area, and inner thighs. Anogenital involvement most commonly affects the groin, mons pubis, vulva (in females), sides of the scrotum (in males), perineum, buttocks and perianal folds.

Signs include:

Many patients with hidradenitis suppurativa also suffer from other skin disorders, including acne, hirsutism and psoriasis.

The severity and extent of hidradenitis suppurativa is recorded at assessment and when determining the impact of a treatment. The Hurley system describes three distinct clinical stages:

  1. Solitary or multiple, isolated abscess formation without scarring or sinus tracts
  2. Recurrent abscesses, single or multiple widely separated lesions, with sinus tract formation
  3. Diffuse or broad involvement, with multiple interconnected sinus tracts and abscesses.

Read more about assessment of severity of hidradenitis suppurativa ...

Severe hidradenitis (Hurley Stage 3) has been associated with:

What is the treatment for hidradenitis suppurativa?

General measures

Medical management of hidradenitis suppurativa

Medical management of hidradenitis suppurativa is difficult. Treatment is required long term. Effective options are listed below.

Antibiotics

Antiandrogens

Immunomodulatory treatments for severe disease

Other medical treatments

Surgical management of hidradenitis suppurativa

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