Hidradenitis suppurativa
last authored: Feb 2010, Kyrie Yujing Wang
last reviewed:
Introduction
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.
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.
Pathophysiology
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.
Signs and Symptoms
- history
- physical exam
History
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
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Diagnostic Imaging
Differential Diagnosis
Treatments
Treatments vary depending on the severity of the disease. Possible treatments and therapy include:
- lifestyle changes, such as avoiding constrictive clothing and conditions which induce sweating
- drainage of pus from large lesions
- surgery, which includes removal of sinus tracts and excision of the affected skin area
- radiation and laser therapy
- oral antibiotics and drugs with anti-inflammatory properties.
- corticosteroid injections, which reduce the body’s inflammatory response
- retinoid supplements, which are forms of Vitamin A shown to reduce oil gland function
Consequences and Course
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
http://www.nlm.nih.gov/medlineplus/hidradenitissuppurativa.html
http://www.healthfinder.gov/orgs/HR3733.htm
Topic Development
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