Hidradenitis suppurativa

last authored: Feb 2010, Kyrie Yujing Wang
last reviewed:



Hidradenitis suppurativa (HS) is a non-contagious form of chronic skin inflammation resulting from the blockage of apocrine sweat and oil glands.




The Case of...

a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.

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Causes and Risk Factors

Factors which trigger flare-up include clothing friction, perspiration, hormonal changes (associated with puberty or menses in women), clothing friction, and cigarette smoking. Rarely does the disease spontaneously resolve itself.

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HS tends to start after puberty, persist for years and worsen over time. Early diagnosis and treatment of hidradenitis suppurativa can help manage the symptoms and prevent new lesions from developing.


HS leads to the formation of painful nodules and drainage of malodrous discharge. Since these nodules are prone to occur in the groin, buttocks, inner thighs, mobility of the patient may be impaired. In addition, HS has a negative impact on the psychological and quality of life of patients. Patients with chronic cases of HS and severe stage III complications have a high risk of developing squamous cell carcinoma, a form of cancer, in the anus or other affected areas.

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Signs and Symptoms

  • history
  • physical exam


Red, painful bumps (lesions) develop in areas where these apocrine glands are located, such as the face, scalp, underarms, groin, buttocks, and areola of the nipple. The lesions may persist for years, with periods of inflammatory flare-ups which lead to lesion enlargement, breakage, and drainage of pus.


Recurrent open lesions are prone to infection and scarring. Sinus tracts, or tunnels under the skin which connect abscesses and infections, may form in more advanced stages of the disease.

Physical Exam


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  • lab investigations
  • diagnostic imaging

Lab Investigations

Diagnostic Imaging


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Differential Diagnosis


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Treatments vary depending on the severity of the disease. Possible treatments and therapy include:



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Consequences and Course


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Additional Resources

Jemec G.B.E., Revuz J., Leyden J.J.:  Hidradenitis suppurativa.  Springer-VerlagBerlin-Heidelberg-New York 2006.  


Jemec G.B., Heidenheim M., Nielsen N.H.:  Hidradenitis suppurativa—characteristics and consequences.  Clin Exp Dermatol 21. 419-423.1996






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Topic Development




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