Hidradenitis Suppurativa

Question 1

What is hidradenitis supprativa?

Answer 1

A chronic, painful, inflammatory skin disorder.

Characterized by the development of inflammatory nodules, pustules, sinus tracts and scars in intertriginous areas.

Question 2

Who should hidradenitis suppurativa be suspected in?

Answer 2

Pubertal or post-pubertal patients who have a diagnosis of recurrent furuncles or boils.

Question 3

What is the epidemiology of hidradenitis suppurativa?

Answer 3

Women > Men

< 40 yo

Question 4

What is the pathogenesis of hidradenitis suppurativa?

Answer 4

Chronic inflammatory occlusion of folliculopilosevaceous units that obstruct the apocrine glands and prevents keratinocytes from properly shedding from the follicular epithelium.

Question 5

What are risk factors for hidradenitis suppurativa?

Answer 5

FHx
Smoking
Obesity, diabetes, PCOS
Mechanical stretching of the skin

Question 6

What are the clinical features of hidradenitis suppurativa?

Answer 6

Recurrent, painful inflamed nodules.
Axilla or intertriginous skin.
Nodules may rupture, discharging purulent, malodorous material.
Coalescence of nodules can result in plaques, sinus tracts and ‘rope-like’ scarring.

Question 7

What is the management of hidradenitis suppurativa?

Answer 7

Encourage good hygiene and good-fitting clothing
Smoking cessation
Weight loss

Steroids - intra-lesional or oral, flucloxacillin

Surgical incision and drainage

Topical clindamycin or oral clindamycin

Question 8

What are the complications of hidradenitis suppurativa?

Answer 8

Sinus tracts, fistulas
Comeodones
Scarring - 'rope like'
Lymphoedema
Contractures
Lymphatic obstruction

Question 9

What is the differential diagnosis of hidradenitis suppurrativa?

Answer 9

Acne vulgaris
Follicular pyodermas (folliculitis)
Granuloma inguinale (donovanosis) - inguinal area, STI