Hidradenitis suppurativa - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that primarily involves intertriginous areas (i.e., axilla, groin, perineum, and inframammary area).
Treatment is often multidisciplinary. Early referral to an appropriate specialist for discussion of medical and surgical options should be considered.
Medical therapy falls into four main categories: antibiotics, anti-inflammatory medications, hormonal agents, and systemic retinoids. Longer courses of antibiotics are often necessary in order to be effective.
HS is associated with significant morbidity, with development of scarring, chronic pain, lymphedema, and impact on social function.

Hidradenitis suppurativa stage I: discrete inflamed nodules and papules with intervening normal skin and lack of scarring

From R.A. Lee, MD, PhD

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Hidradenitis suppurativa stage I: discrete inflamed nodules and papules with intervening normal skin and lack of scarring
Hidradenitis suppurativa stage II: inflamed nodules and scars with areas of intervening normal skin
Hidradenitis suppurativa stage III: interconnected scars, cysts, comedones, and inflamed nodules
Hidradenitis suppurativa: fluctuant abscess in axilla
Hidradenitis suppurativa: open "double" comedones
Hidradenitis suppurativa: linear scars
Hidradenitis suppurativa: draining sinus tracts

Citations

Key Articles

Kim WB, Sibbald RG, Hu H, et al. Clinical features and patient outcomes of hidradenitis suppurativa: a cross-sectional retrospective study. J Cutan Med Surg. 2016;20:52-57.[Abstract][Full Text]
Martorell A, García-Martínez FJ, Jiménez-Gallo D, et al. An update on hidradenitis suppurativa (part I): epidemiology, clinical aspects, and definition of disease severity. Actas Dermosifiliogr. 2015;106:703-715.[Abstract][Full Text]
Sabat R, Jemec GBE, Matusiak Ł, et al. Hidradenitis suppurativa. Nat Rev Dis Primers. 2020 Mar 12;6(1):18.[Abstract]
Martorell A, García FJ, Jiménez-Gallo D, et al. Update on hidradenitis suppurativa (part II): treatment. Actas Dermosifiliogr. 2015;106:716-724.[Abstract][Full Text]
Kimball AB, Okun MM, Williams DA, et al. Two phase 3 trials of adalimumab for hidradenitis suppurativa. N Engl J Med. 2016;375:422-34.[Abstract][Full Text]
Ingram JR, Woo PN, Chua SL, et al. Interventions for hidradenitis suppurativa. Cochrane Database Syst Rev. 2015;(10):CD010081.[Abstract][Full Text]

Other Online Resources

iPledge system (for isotretinoin prescribing)
Hope for HS

Referenced Articles

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5. Kim WB, Sibbald RG, Hu H, et al. Clinical features and patient outcomes of hidradenitis suppurativa: a cross-sectional retrospective study. J Cutan Med Surg. 2016;20:52-57.[Abstract][Full Text]
6. Martorell A, García-Martínez FJ, Jiménez-Gallo D, et al. An update on hidradenitis suppurativa (part I): epidemiology, clinical aspects, and definition of disease severity. Actas Dermosifiliogr. 2015;106:703-715.[Abstract][Full Text]
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19. Sabat R, Jemec GBE, Matusiak Ł, et al. Hidradenitis suppurativa. Nat Rev Dis Primers. 2020 Mar 12;6(1):18.[Abstract]
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23. Wright S, Strunk A, Garg A. New-onset depression among children, adolescents, and adults with hidradenitis suppurativa. J Am Acad Dermatol. 2020 Nov;83(5):1360-6.[Abstract]
24. Jørgensen AR, Yao Y, Ghazanfar MN, et al. Burden, predictors and temporal relationships of comorbidities in patients with hidradenitis suppurativa: a hospital-based cohort study. J Eur Acad Dermatol Venereol. 2020 Mar;34(3):565-73.[Abstract]
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26. Acharya P, Mathur M. Hidradenitis suppurativa and smoking: a systematic review and meta-analysis. J Am Acad Dermatol. 2020 Apr;82(4):1006-11.[Abstract][Full Text]
27. Garg A, Papagermanos V, Midura M, et al. Incidence of hidradenitis suppurativa among tobacco smokers: a population-based retrospective analysis in the USA. Br J Dermatol. 2018 Mar;178(3):709-14.[Abstract]
28. Kurzen H, Kurokawa I, Jemec GB, et al. What causes hidradenitis suppurativa? Exp Dermatol. 2008;17:455-456.[Abstract][Full Text]
29. Ingram JR. The genetics of hidradenitis suppurativa. Dermatol Clin. 2016 Jan;34(1):23-8.[Abstract]
30. Dufour DN, Emtestam L, Jemec GB. Hidradenitis suppurativa: a common and burdensome, yet under-recognised, inflammatory skin disease. Postgrad Med J. 2014 Apr;90(1062):216-21; quiz 220.[Abstract][Full Text]
31. Schrader AM, Deckers IE, van der Zee HH, et al. Hidradenitis suppurativa: a retrospective study of 846 Dutch patients to identify factors associated with disease severity. J Am Acad Dermatol. 2014 Sep;71(3):460-7.[Abstract]
32. Li A, Peng Y, Taiclet LM, et al. Analysis of hidradenitis suppurativa-linked mutations in four genes and the effects of PSEN1-P242LfsX11 on cytokine and chemokine expression in macrophages. Hum Mol Genet. 2019 Apr 1;28(7):1173-82.[Abstract][Full Text]
33. Wang Z, Yan Y, Wang B. γ-Secretase genetics of hidradenitis suppurativa: a systematic literature review. Dermatology. 2021;237(5):698-704.[Abstract][Full Text]
34. Hunger RE, Laffitte E, Läuchli S, et al. Swiss practice recommendations for the management of hidradenitis suppurativa/acne inversa. Dermatology. 2017;233(2-3):113-9.[Abstract][Full Text]
35. von der Werth JM, Williams HC. The natural history of hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2000;14:389-392.[Abstract]
36. Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part I: Diagnosis, evaluation, and the use of complementary and procedural management. J Am Acad Dermatol. 2019 Jul;81(1):76-90.[Abstract][Full Text]
37. Dauden E, Lazaro P, Aguilar MD, et al. Recommendations for the management of comorbidity in hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2018 Jan;32(1):129-44.[Abstract]
38. Nielsen VW, Jørgensen AR, Thomsen SF. Fatal outcome of malignant transformation of hidradenitis suppurativa: a case report and literature review. Clin Case Rep. 2020 Mar;8(3):504-7.[Abstract][Full Text]
39. Lee SJ, Lim JM, Lee SH, et al. Invasive cutaneous squamous cell carcinoma arising from chronic hidradenitis suppurativa: a case report of treatment by slow mohs micrographic surgery. Ann Dermatol. 2021 Feb;33(1):68-72.[Abstract][Full Text]
40. Poveda I, Vilarrasa E, Martorell A, et al. Serum zinc levels in hidradenitis suppurativa: a case-control study. Am J Clin Dermatol. 2018 Oct;19(5):771-7.[Abstract]
41. Martorell A, García FJ, Jiménez-Gallo D, et al. Update on hidradenitis suppurativa (part II): treatment. Actas Dermosifiliogr. 2015;106:716-724.[Abstract][Full Text]
42. Ingram JR, Collier F, Brown D, et al. British Association of Dermatologists guidelines for the management of hidradenitis suppurativa (acne inversa) 2018. Br J Dermatol. 2019 May;180(5):1009-17.[Abstract][Full Text]
43. Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part II: Topical, intralesional, and systemic medical management. J Am Acad Dermatol. 2019 Jul;81(1):91-101.[Abstract][Full Text]
44. Zouboulis CC, Bechara FG, Dickinson-Blok JL, et al. Hidradenitis suppurativa/acne inversa: a practical framework for treatment optimization - systematic review and recommendations from the HS ALLIANCE working group. J Eur Acad Dermatol Venereol. 2019 Jan;33(1):19-31.[Abstract][Full Text]
45. Chahine AA, Nahhas AF, Braunberger TL, et al. Ertapenem rescue therapy in hidradenitis suppurativa. JAAD Case Rep. 2018 Jun;4(5):482-3.[Abstract]
46. Join-Lambert O, Coignard-Biehler H, Jais JP, et al. Efficacy of ertapenem in severe hidradenitis suppurativa: a pilot study in a cohort of 30 consecutive patients. J Antimicrob Chemother. 2016 Feb;71(2):513-20.[Abstract][Full Text]
47. Riis PT, Boer J, Prens EP, et al. Intralesional triamcinolone for flares of hidradenitis suppurativa (HS): a case series. J Am Acad Dermatol. 2016 Dec;75(6):1151-5.[Abstract]
48. Leiphart P, Ma H, Naik HB, et al. The effect of antimicrobial washes on antibacterial resistance in hidradenitis suppurativa lesions. J Am Acad Dermatol. 2019 Mar;80(3):821-2.[Abstract][Full Text]
49. Jemec GB, Wendelboe P. Topical clindamycin versus systemic tetracycline in the treatment of hidradenitis suppurativa. J Am Acad Dermatol. 1998;39:971-4.[Abstract]
50. Kromann CB, Ibler KS, Kristiansen VB, et al. The influence of body weight on the prevalence and severity of hidradenitis suppurativa. Acta Derm Venereol. 2014 Sep;94(5):553-7.[Abstract][Full Text]
51. Gener G, Canoui-Poitrine F, Revuz JE, et al. Combination therapy with clindamycin and rifampicin for hidradenitis suppurativa: a series of 116 consecutive patients. Dermatology. 2009;219:148-54.[Abstract]
52. Schneller-Pavelescu L, Vergara-de Caso E, Martorell A, et al. Interruption of oral clindamycin plus rifampicin therapy in patients with hidradenitis suppurativa: An observational study to assess prevalence and causes. J Am Acad Dermatol. 2019 May;80(5):1455-7.[Abstract][Full Text]
53. Zouboulis CC, Desai N, Emtestam L, et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol. 2015 Apr;29(4):619-44.[Abstract]
54. Mendes-Bastos P, Macedo R, Duarte R. Treatment of hidradenitis suppurativa with rifampicin: have we forgotten tuberculosis? Br J Dermatol. 2017 Oct;177(4):e150-e151.[Abstract]
55. Yazdanyar S, Boer J, Ingvarsson G, et al. Dapsone therapy for hidradenitis suppurativa: a series of 24 patients. Dermatology. 2011;222(4):342-6.[Abstract]
56. Nikolakis G, Kyrgidis A, Zouboulis CC. Is there a role for antiandrogen therapy for hidradenitis suppurativa? A systematic review of published data. Am J Clin Dermatol. 2019 Aug;20(4):503-13.[Abstract]
57. Boer J, van Gemert MJ. Long-term results of isotretinoin in the treatment of 68 patients with hidradenitis suppurativa. J Am Acad Dermatol. 1999;40:73-6.[Abstract]
58. Boer J, Nazary M. Long-term results of acitretin therapy for hidradenitis suppurativa. Br J Dermatol. 2010;164:170-5.[Abstract]
59. Blok JL, van Hattem S, Jonkman MF, et al. Systemic therapy with immunosuppressive agents and retinoids in hidradenitis suppurativa: a systematic review. Br J Dermatol. 2013;168:243-52.[Abstract]
60. van der Zee HH, Prens EP, Boer J. Deroofing: a tissue-saving surgical technique for the treatment of mild to moderate hidradenitis suppurativa lesions. J Am Acad Dermatol. 2010;63:475-480.[Abstract]
61. Tierney E, Mahmoud BH, Hexsel C, et al. Randomized control trial for the treatment of hidradenitis suppurativa with a neodymium-doped yttrium aluminium garnet laser. Dermatol Surg. 2009;35:1188-1198.[Abstract]
62. Mahmoud BH, Tierney E, Hexsel CL, et al. Prospective controlled clinical and histopathologic study of hidradenitis suppurativa treated with the long-pulsed neodymium:yttrium-aluminium-garnet laser. J Am Acad Dermatol. 2010;62:637-645.[Abstract]
63. Hazen PG, Hazen BP. Hidradenitis suppurativa: successful treatment using carbon dioxide laser excision and marsupialization. Dermatol Surg. 2010;36:208-213.[Abstract]
64. Kimball AB, Okun MM, Williams DA, et al. Two phase 3 trials of adalimumab for hidradenitis suppurativa. N Engl J Med. 2016;375:422-34.[Abstract][Full Text]
65. Tzanetakou V, Kanni T, Giatrakou S, et al. Safety and efficacy of anakinra in severe hidradenitis suppurativa: a randomized clinical trial. JAMA Dermatol. 2016 Jan;152(1):52-9. [Abstract][Full Text]
66. Molinelli E, Brisigotti V, Simonetti O, et al. Efficacy and safety of topical resorcinol 15% as long-term treatment of mild-to-moderate hidradenitis suppurativa: a valid alternative to clindamycin in the panorama of antibiotic resistance. Br J Dermatol. 2020 Dec;183(6):1117-9.[Abstract]
67. Pascual JC, Encabo B, Ruiz de Apodaca RF, et al. Topical 15% resorcinol for hidradenitis suppurativa: An uncontrolled prospective trial with clinical and ultrasonographic follow-up. J Am Acad Dermatol. 2017 Dec;77(6):1175-8.[Abstract]
68. Blok JL, Li K, Brodmerkel C, et al. Ustekinumab in hidradenitis suppurativa: clinical results and a search for potential biomarkers in serum. Br J Dermatol. 2016 Apr;174(4):839-46.[Abstract]
69. Takeda K, Kikuchi K, Kanazawa Y, et al. Ustekinumab treatment for hidradenitis suppurativa. J Dermatol. 2019 Dec;46(12):1215-8.[Abstract]
70. Kashetsky N, Mufti A, Alabdulrazzaq S, et al. Treatment outcomes of IL-17 inhibitors in hidradenitis suppurativa: a systematic review. J Cutan Med Surg. 2021 Aug [Epub ahead of print].[Abstract]
71. ClinicalTrials.gov. Secukinumab/hidradenitis suppurativa phase 3 interventional studies [internet publication].[Full Text]
72. Babbush KM, Andriano TM, Cohen SR. Antiandrogen therapy in hidradenitis suppurativa: finasteride for females. Clin Exp Dermatol. 2021 Jul 14 [Epub ahead of print].[Abstract]
73. Ingram JR, Woo PN, Chua SL, et al. Interventions for hidradenitis suppurativa. Cochrane Database Syst Rev. 2015;(10):CD010081.[Abstract][Full Text]
74. John H, Manoloudakis N, Stephen Sinclair J. A systematic review of the use of lasers for the treatment of hidradenitis suppurativa. J Plast Reconstr Aesthet Surg. 2016 Oct;69(10):1374-81.[Abstract]
75. Montero-Vilchez T, Diaz-Calvillo P, Rodriguez-Pozo JA, et al. The burden of hidradenitis suppurativa signs and symptoms in quality of life: systematic review and meta-analysis. Int J Environ Res Public Health. 2021 Jun 22;18(13):6709.[Abstract][Full Text]
76. Patel ZS, Hoffman LK, Buse DC, et al. Pain, psychological comorbidities, disability, and impaired quality of life in hidradenitis suppurativa [corrected]. Curr Pain Headache Rep. 2017 Nov 1;21(12):49.[Abstract]
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78. Faye O, Petit F, Poli F, et al. Lymphedema as a complication of hidradenitis suppurativa in three patients [in French]. Ann Dermatol Venereol. 2007;134:567-569.[Abstract]
79. Maclean GM, Coleman DJ. Three fatal cases of squamous cell carcinoma arising in chronic perineal hidradenitis suppurativa. Ann R Coll Surg Engl. 2007;89:709-712.[Abstract][Full Text]