Clinical presentation

Abstract

Hidradenitis suppurativa (HS) is a distinctive chronic disease primarily located to inverse areas of the skin, e.g. axillae and groin. These areas generally may also be said to be apocrinegland- bearing skin, although the apocrine glands are not primarily involved in the disease. In the early stages the disease is an inflammatory and pustular follicular disease, but subsequently it becomes predominantly suppurative and scarring. In addition to the objective clinical manifestations of the disease, the inflammatory changes and suppuration cause immediate pain, soreness and discomfort to the patients. In spite of the distinctness of HS it is commonly misdiagnosed and frequently poorly managed, which adds to the burden of this disabling chronic disease, which severely impairs the quality of life. Epidemiological and clinical observations may be of help, as corroborating evidence, in establishing the diagnosis of HS. Generally, HS develops almost always after puberty, usually in the second or third decade of life. It is not an uncommon disease with a prevalence rate of 1% [8]. Women are more frequently affected than men; the sex ratio is 3:1 [1, 7, 8]. This has led to speculation about the aetiological role of endocrine and behavioural factors, although none of these have hitherto been found to be convincing on closer examination. Epidemiological studies however suggest that tobacco may play an aetiological or more likely a pathogenic role in the disease, as 84% of patients are current smokers [1]. Another frequently suspected aetiological/ pathogenic factor is obesity. Being overweight is not uncommon but not a unifying characteristic of the patients either: among the 164 patients of a personal series [1] 20% were overweight and 20% obese (body mass index, BMI, >30 kg/m2). The median BMI was, however, 23.6 kg/m2, which may be considered normal. Similarly, another earlier series found no significant deviation from ideal body weight in a series of 76 patients as a whole [6]. It is most likely that these factors play a role as pathogenic elements in the progression of the disease and in the severity of the disease rather than as actual aetiological factors.