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Highlights & Basics
- 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.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
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
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]
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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]
7. Jfri A, Nassim D, O'Brien E, et al. Prevalence of hidradenitis suppurativa: a systematic review and meta-regression analysis. JAMA Dermatol. 2021 Aug 1;157(8):924-31.[Abstract]
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9. Garg A, Kirby JS, Lavian J, et al. Sex- and age-adjusted population analysis of prevalence estimates for hidradenitis suppurativa in the United States. JAMA Dermatol. 2017 Aug 1;153(8):760-64.[Abstract][Full Text]
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18. Saunte DM, Boer J, Stratigos A, et al. Diagnostic delay in hidradenitis suppurativa is a global problem. Br J Dermatol. 2015 Dec;173(6):1546-9.[Abstract]
19. Sabat R, Jemec GBE, Matusiak Ł, et al. Hidradenitis suppurativa. Nat Rev Dis Primers. 2020 Mar 12;6(1):18.[Abstract]
20. Phan K, Charlton O, Smith SD. Hidradenitis suppurativa and metabolic syndrome - systematic review and adjusted meta-analysis. Int J Dermatol. 2019 Oct;58(10):1112-7.[Abstract]
21. Tzellos T, Zouboulis CC, Gulliver W, et al. Cardiovascular disease risk factors in patients with hidradenitis suppurativa: a systematic review and meta-analysis of observational studies. Br J Dermatol. 2015 Nov;173(5):1142-55.[Abstract]
22. Vazquez BG, Alikhan A, Weaver AL, et al. Incidence of hidradenitis suppurativa and associated factors: a population-based study of Olmsted County, Minnesota. J Invest Dermatol. 2013 Jan;133(1):97-103.[Abstract][Full Text]
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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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]
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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]
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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]
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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]
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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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