Hidradenitis suppurativa

This inflammatory condition affects the skin that contains apocrine glands in the axilla, groin, anogenital region, and the breast folds. There is follicular occlusion which then causes inflammation. This inflammation causes destruction of the apocrine glands leading to secondary bacterial infection.

Patients experience recurrent abscesses which can discharge pus and then leave sinuses and scarring. Examination shows comedones; pustules; abscesses; sinuses; scars; pyogenic granulomas; and papules.

It often begins at puberty. Risk factors include: obesity; family history; female; smoking; inflammatory bowel disease; other follicular occlusion disorders (e.g. acne, pilonidal cysts)

Treatment includes preventative measures such as weight loss, smoking session and wearing loose fitting clothing. 

Medical treatment options include: antibiotics; anti-inflammatories; hormone treatment; and systemic retinoids. Hydradenitis suppurativa is graded using the Hurley staging system and this helps guide treatment.

A course of flucloxacillin can be used to treat Staph infection in abscesses. Sometimes a longer course of antibiotics e.g. erythromycin or tetracycline (for a few months) can be used as an anti-inflammatory treatment. Antiseptic washes are often used too.

Dapsone has been used with good effect.

Long-treatment includes anti-androgens (e.g. the oral contraceptive pill) or spironolactone. Metformin has been shown to improve disease severity and this though to be due to anti-androgen effects.

Isoretinoin has been used but with limited evidence of efficacy. Acitretin has shown better results, but is highly teratogenic.

Surgical treatments are often needed too. Incision and drainage of the abscess does not prevent recurrence but surgery can be used to remove the scar tissue. Excision of apocrine glands or deroofing of lesions and laser ablation are also options.



Diagnosis and management of hidradenitis suppurativa