Hidradenitis suppurativa

Abstract

Hidradenitis suppurativa is a chronic disease characterized by recurrent inflammatory nodules, sinus tracts with suppuration, abscesses and scarring in the skin folds containing terminal hair and apocrine glands. Hidradenitis suppurativa usually manifests after puberty, most often in the third decade; and persists into old age. The prevalence of the disease is approximately 1%. Axillary and inguinal involvement is more common in females, perianal and gluteal areas are predominantly affected in males. The exact etio-pathology is still unknown. The primary event is hyperkeratosis leading to follicular occlusion with distension and destruction of infundibulum that provokes large inflammatory reaction in the adjacent tissue. Smoking and obesity may be potential triggering factors. Squamous cell carcinoma and arthropathy belong to the main complications of hidradenitis suppurativa. Treatment depends on the stage of the disease. Topical therapy with antibiotics, antiseptics or long-term systemic antibiotic therapy is suitable for initial and mild forms. In advanced stages, systemic retinoids, antiandrogens, steroids or cyclosporin A are used and anti-TNF drugs have shown promising effect in the severe cases, recently. Total wide excision of the affected area remains the only curative procedure.