Hidradenitis suppurativa

Hidradenitis suppurativa is a refractory, chronic inflammatory follicular disorder in the apocrine gland bearing areas of the axillary, inguinal, and inframammary areas,  involving the skin and subcutaneous tissue

-HS is not a primary infectious process but rather inflammatory.

-It is more common in women.

-Areas commonly affected: Axillae, inguinal areas, breasts, inframammary areas,inner thighs, buttocks, perianal, perineal regions

-HS is most common in the axilla and inguinal area

-Perineal disease is more common in males, whereas axillary disease is more common in females.

-Risk factors: Obesity, smoking, and tight-fitting clothing.

Symptoms & Signs

Patients typically report a gradual onset of persistent or recurrent boil-like lesions in the axillae and/or inguinal area.


The diagnosis is made clinically

Stage one: Single or multiple abscesses or nodules

Stage two: Nonconfluent, recurrent abscesses, or nodules with sinus tracts and scars.

Stage three: Similar to stage two, but lesions are diffuse and affect an entire region.


General measures: Smoking cessation, weight loss if overweight, and avoidance of tight-fitting clothes

Stage one: Topical clindamycin, oral antibiotics

Stage two: Stage one therapies, intralesional corticosteroids, oral retinoids (acitretin, isotretinoin, alitretinoin);Hormones (Cyproterone acetate, oral contraceptives), incision and drainage, surgical procedures

Stage three: infliximab, Adalimumab, Extensive excision of the affected area, laser therapy


HS can end as large abscesses and fistulas. Other complications include strictures, contractures, depression, suicide, arthritis, squamous cell carcinoma

Q: What is the most common presentation of HS? painful, tender, firm, nodular lesions in axillae

Q: Who is the typical patient of HS? Obese, postpubertal female.

Q: What is the most common site of HS? Axilla

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