Author: Vanessa Ngan, Staff Writer; Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand. 1997. Updated December 2015.
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. Hidradenitis suppurativa also has a significant psychological impact, and many patients suffer from impairment of body image, depression and anxiety.
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.
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 three 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).
Hidradenitis suppurativa is an autoinflammatory disorder. Although the exact cause is not yet understood, contributing factors include:
Hidradenitis can affect 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.
The severity and extent of hidradenitis suppurativa are recorded at assessment and when determining the impact of a treatment. The Hurley system describes three distinct clinical stages:
Severe hidradenitis (Hurley Stage 3) has been associated with:
Medical management of hidradenitis suppurativa is difficult. Treatment is required long term. Effective options are listed below.
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