Hidrosadenitis Suppurativa is a chronic skin condition characterized by swollen, painful, inflamed lesions in the axillae, groin, buttocks and other parts of the body that contain apocrine glands. It is more commonly found in women and can be present under the breasts.

 

The hallmark of Hidrosadenitis Suppurativa is sinus tracts (which can become draining fistulas) in the apocrine gland body areas.

Common sites of hidradenitis suppurativa

• Hidradenitis suppurativa is confined to areas of the body that contain apocrine glands.
• These areas are the axillae, areola of the nipple, groin, perineum, circumanal, and periumbilical regions.
• Often, patients with hidradenitis suppurativa also are afflicted with acne, pilonidal cysts, and chronic scalp folliculitis.

Signs and symptoms

• Common presentation is painful, tender, firm, nodular lesions under the arms.
• The nodules may open and drain pus spontaneously. Nodules will heal slowly, with or without drainage, over 15- 20 days.
• Typically nodules recur at least several times yearly. 

Stages of hidradenitis suppurativa

Stages	Characteristics
1	Solitary or multiple abcess formation without scarring or sinus tracts
2	Recurrent abscesses, single or multiple widely separated lesions, with sinus tract formation- requires incision and drainage
3	Diffuse or broad involvement across a regional area with multiple interconnected sinus tracts and abscesses. Fistula, scarring, and frequent recurring infections.

 

Causes

Genetic predisposition

Aggravating factors are excessive heat, perspiration, tight clothing, obesity, and cigarettes

Hidradenitis suppurativa association with the following conditions

• Crohn disease
• Irritable bowel syndrome
• Down syndrome
• Certain forms of arthritis
• Graves disease or Hashimoto thyroiditis
• Sjogren syndrome
• Herpes simplex

Tests and diagnosis

• Complete blood count
• Cultures from exudates
• Blood cultures
• Thyroid function test

Complications

Stage-3 Hidradenitis suppurativa can lead to the development of squamous cell carcinoma in the anus or other affected areas

Treatment

Life style changes

Diet – avoid inflammatory foods like junk and spicy foods, highly refined carbohydrates, and fatty foods.

Medications

• Hexachlorophene shower with liquid soap like Phisohex, covering sores with Metrolotion
• Corticosteroid injections
• Antibiotics in the presence of bacterial infection
• Vitamin A supplementation
• Anti-androgen therapy
• Acitretin
• Zinc gluconate taken orally has been shown to induce remission
• Hibiclens + Gold Dial antibiotic soap Hibiclens is an antiseptic/antibiotic found in walgreens