Hidradenitis Suppurativa

 Hidradenitis Suppurativa (HS)

 

·         Hidradenitis Suppurativa is a chronic inflammatory process that affects the skin and subcutaneous tissue of the axillae, anogenital, and breast regions. 

·         Severity of disease varies among patients.  Pts will present with recurrent tender, subcutaneous, inflammatory nodules or even painful, deep dermal abscesses.  Can see fibrosis, draining sinuses/tracts and scarring.

·         HS is due to follicular plugging of the apocrine glands followed by a secondary bacterial infection.  The classic appearance is a double comedone ( a blackhead with two or more openings that communicate below the skin’s surface). Pt may have these lesions for years without additional symptoms.

·         Incidence peaks in the 2nd and 3rd decades (declines by the 5th decade); more common in women than in men (3:1)

·         Underlying cause is unknown; however hormonal and genetic etiology is suggested

o   Numerous studies show elevation in proinflammatory cytokines (IL-1B, IL-17 and TNF-α)

·         Significant associations with:

o   Obesity; insulin resistance; metabolic syndrome

o   Acne

o   Comedones

o   Hirsutism

o   PCOS 

·         Diagnosis

o   Diagnosis is made clinically

o   Widely underdiagnosed consider comorbidities such as actinomycosis, carbuncles, cat scratch disease, crohns, granuloma inguinale, bartholin’s cyst, sebaceous cyst, lymphadenitis, pinonidal sinus, lymphogranuoma venereum, and ulcerative colitis