Hidradenitis Suppurativa

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Introduction

Hidradenitis suppurativa, also known as acne inversa, is a chronic in
gland-bearing skin of the axillae, infra-mammary folds, buttocks and groin.
1
It is caused by blocked hair follicles, which are connected to apocrine sweat glands, resulting in the formation of recurrent
pus-
1
Hidradenitis suppurativa often begins during puberty and is more common in females and people with skin of colour.
1,2
Hidradenitis suppurativa a
2,3

Aetiology

The exact pathogenesis of hidradenitis suppurativa is unknown; however, it is an auto-in
involved in the development of hidradenitis suppurative include\:
1
Follicular occlusion
An abnormal cutaneous microbiome
In

Risk factors

Factors which are associated with an increased risk of developing hidradenitis suppurativa include\:
1,2
Family history of hidradenitis suppurativa
Obesity and insulin resistance
Cigarette smoking
African ethnicity
InCrohn’s disease
Acne
Dissecting scalp cellulitis
Poor hygiene does not cause hidradenitis suppurativa.

Clinical features

History
Patients with hidradenitis suppurativa typically describe recurrent boil-like nodules and abscesses with purulent
discharge in the axillae, inframammary fold, groin and inner thigh.
A single area or multiple areas can be a
tenderness and pain.Patients can experience profound psychosocial impact due to this condition, with anxiety, depression and impairment of
body image being commonly reported.
1
Clinical examination
On examination of the skin, open double-headed comedones, tender in
be seen.
Draining sinuses can develop, linking the in
formation over time.
1
The Hurley System describes three clinical stages of hidradenitis suppurativa based on severity\:
1
Stage 1\: solitary or multiple isolated abscess formation without sinus tracts or scarring
Stage 2\: recurrent abscesses, single or multiple widely spaced lesions, with sinus tract formation or scarring
Stage 3\: di
Figure 1. Hurley stage 1. 4
Figure 2. Hurley stage 2. 5Figure 3. Hurley stage 3. 6

Di

The di
1
Staphylococcal skin infections such as carbuncles
Cutaneous/anogenital Crohn’s disease
Cysts such as Bartholin’s cyst or epidermoid cyst

Investigations

Extensive investigations are rarely required. Bacterial swabs are usually negative, which is a clue to the diagnosis.
1
If recurrent gastrointestinal symptoms are reported, patients should be referred for in
7

Diagnosis

Hidradenitis suppurativa is a clinical diagnosis. The following triad must be met for a diagnosis to be made\:
1
1. The presence of characteristic lesions (nodules, pustules, abscesses)
2. In a typical distribution (i.e. axillae, inframammary fold, groin)
3. Recurrent nature of the lesions

Management

General measures
There is no cure for hidradenitis suppurativa, but it can become inactive over time and with treatment.
2
Patients with hidradenitis suppurativa should be screened for associated co-morbidities such as depression, anxiety,
diabetes, hypertension, hyperlipidaemia and obesity.
7
If patients are smoking, they should be encouraged to quit. 1
If patients are obese, they should be encouraged to lose
weight. 2 8Worsening prognosis occurs when there is a delay in diagnosis and management during the early disease stage.Topical therapies
Clindamycin 1% solution can be applied to the a
7
Systemic therapies
Antibiotics
7
Initial treatment is with oral tetracycline antibiotics such as doxycycline for 12 weeks. In patients who are unresponsive to
oral tetracycline antibiotics, combination treatment with oral clindamycin and rifampicin can be trialled.
7
Other oral agents
In patients who are not responding to oral antibiotics, oral dapsone can be trialled. 7
are unresponsive to oral antibiotics, oral acitretin, a vitamin A derivative, can be used.
7
In males and non-fertile females who
Biologics
The TNF alpha-inhibitor, adalimumab, can be used in patients with moderate-severe hidradenitis suppurativa who are
unresponsive to conventional systemic therapy.
7
Other management options
Intralesional corticosteroid injections can be used in the acute phase in carefully selected patients.
7
Surgical excision can be considered in certain individuals with localised disease or where conventional systemic therapies
have failed to minimise the recurrence rate.
7

Complications

Complications of hidradenitis suppurativa include\:
1,7
Superimposed infection
Psychological impacts such as anxiety, depression, poor self-image,
Genital lymphedema
In
Cutaneous squamous cell carcinoma
Anaemia

Key points

Hidradenitis suppurativa is a chronic auto-in
in
It a
Risk factors for the development of hidradenitis suppurativa include positive family history, obesity, insulin resistance,
cigarette smoking and in
Symptoms of hidradenitis suppurativa include tender in
malodour, pain and psychosexual distress
Clinical
comedones, sinus tract formation and scarring are more common with moderate-severe hidradenitis suppurativa
Hidradenitis suppurativa is a clinical diagnosis
Management includes topical and oral antibiotics, intra-lesional steroids, surgery and systemic therapies including
biologics
Lifestyle modi
Complications of hidradenitis suppurativa include superimposed infection, scarring, psychosexual distress, anaemia and
cutaneous squamous cell carcinomaReferences
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Reviewer

Dr Myranda Attard
Dermatology Specialist Registrar
Belfast Health and Social Care Trust

Related notes

Acne vulgaris
Basal Cell Carcinoma (BCC)
Cellulitis
Cutaneous Squamous Cell Carcinoma (SCC)
Erythema Multiforme

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Contents

Introduction
Aetiology
Risk factors
Clinical features
Source\: geekymedics.com