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4.1. Diseases of sebaceous and apocrine glands
4.1.4 Hidradenitis Suppurativa
Grading & Level of Importance: C
W. Burgdorf, Munich; F. Bakr, A. Salam, J. McGrath, London;
Revised by C.C. Zouboulis, Dessau
Aetiology & Pathogenesis
Laboratory & other workups
Prevention & Therapy
ED92.0
Acne inversa; pyodermia fistulans sinifica.
Prevalence 0.03-4% (average 1%), annual age- and sex-adjusted incidence 6.0 per 100,000. Male:female ratio 1:3.
Chronic, inflammatory, recurrent, debilitating skin disease (of the terminal hair follicle) usually presenting after puberty with painful, deep-seated, inflamed lesions in the apocrine gland-bearing areas of the body, most commonly the axillary, inguinal, and ano-genital regions.
The exact pathogenetic mechanism of hidradenitis suppurativa remains unclear. Smoking, obesity and metabolic syndrome are major predisposing factors.
Chronic recurrent inflammatory nodules, abscesses, draining tunnels (sinuses, fistulae and double comedones) and scars.
Mostly intertriginous occurrence.
Combination of anatomical classification: Hurley I, II, III and severity classification: mild, moderate, severe.
Syndromic hidradenitis suppurativa diseases.
C-reactive protein, erythrocyte sedimentation rate.
Heterogeneous histological pattern with hyperplasia of hair follicular epithelium and subepidermal and deep cellular inflammatory infiltrate.
Acute and chronic.
Squamous cell carcinoma in chronic ano-genital lesions, deep scars, depression, unemployment, change of profession.
Outbreak of boils during the last 6 months with a minimum of 2 boils in one of the following 6 locations: axilla, groin, genitals, buttocks, under the breasts and perianal area, neck and abdomen regions.
Staphylococcal infection (furuncle, carbuncle), cutaneous Crohn's disease , primary or metastatic tumors, lymphogranuloma venereum, apocrine abscess.
Active inflammatory stage
Mild: Topical clindamycin, topical antimicrobials.
Moderate: Oral clindamycin plus rifampicin; tetracycline; adalimumab; acitretin.
Severe: Adalimumab +/- clindamycin/doxycycline.
Chronic including inactive (non-inflammatory) stage.
Local or wide excision.
Weight loss and tobacco abstinence, pain management, treatment of secondary infections.
Comorbid disorders: Inflammatory bowel disease, spondylarthropathy, increased cardiovascular risk.
Syndromic hidradenitis suppurativa diseases are rare.
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29 -year-old woman presents with recurrent painful, sometimes draining, nodules in the perianal and inguinal region, extending to the thighs and labia majora.
Peripheral circulatory disturbances with signs such as acrocyanosis and cutis marmorata are possible signs of a predisposition for:
Which statements apply to hidradenitis suppurativa?
Statement 1 Hidradenitis suppurativa can on rare occasion lead to bladder or rectal fistulas
Statement 1 Deodorants are a proven trigger for hidradenitis suppurativa
What are typical locations for hidradenitis suppurativa?
Which of the following statements about hidradenitis suppurativa are true?
Which of the following statements apply to hidradenitis suppurativa?
Further Images / DOIA
Hidradenitis Suppurativa definition
D.M.L. Saunte, G.B.E. Jemec: Hidradenitis Suppurativa: Advances in Diagnosis and Treatment (2017)
A. Alikhan, P.J. Lynch, D.B. Eisen: Hidradenitis suppurativa: A comprehensive review (2017)
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