Hidradenitis Suppurativa

Abstract

Hidradenitis suppurativa (HS) is a chronic, follicular occlusive, inflammatory skin condition. It affects the intertriginous skin areas of the axillary, groin, perianal, perineal, and inframammary regions. It presents as recurrent, inflamed nodules and abscesses, draining sinus tracts and bands of severe scar formation. It is associated with pain, bad odor, discharge, and disfigurement. Severity of the disease is staged clinically according to the Hurley staging system. Treatment should include avoidance of trauma to the skin, discontinuation of smoking, and losing weight. The affected region should be washed by antiseptics. In addition, pain should be managed; topical clindamycin cream and topical resorcinol may be applied. Other treatments are intralesional corticosteroid injections and oral tetracyclines. Systemic glucocorticoids, cyclosporine, or the TNF-alpha inhibitors—adalimumab and infliximab—are sometimes tried. In severe cases cold knife or CO₂ laser excision of lesions may be used to unroof the lesions, nodules, or sinuses. Wide excision is appropriate for advanced disease. Extensive excisions with skin grafts are also used.