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ED92.0
4.1.4 Hidradenitis Suppurativa
Grading & Level of Importance: C
ICD-11
Synonyms
Acne inversa; pyodermia fistulans sinifica.
Epidemiology
Prevalence 0.03-4% (average 1%), annual age- and sex-adjusted incidence 6.0 per 100,000. Male:female ratio 1:3.
Definition
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.
Aetiology & Pathogenesis
The exact pathogenetic mechanism of hidradenitis suppurativa remains unclear. Smoking, obesity and metabolic syndrome are major predisposing factors.
Signs & Symptoms
Chronic recurrent inflammatory nodules, abscesses, draining tunnels (sinuses, fistulae and double comedones) and scars.
Localisation
Mostly intertriginous occurrence.
Classification
Combination of anatomical classification: Hurley I, II, III and severity classification: mild, moderate, severe.
Syndromic hidradenitis suppurativa diseases.
Laboratory & other workups
C-reactive protein, erythrocyte sedimentation rate.
Dermatopathology
Heterogeneous histological pattern with hyperplasia of hair follicular epithelium and subepidermal and deep cellular inflammatory infiltrate.
Course
Acute and chronic.
Complications
Squamous cell carcinoma in chronic ano-genital lesions, deep scars, depression, unemployment, change of profession.
Diagnosis
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.
Differential diagnosis
Staphylococcal infection (furuncle, carbuncle), cutaneous Crohn’s disease , primary or metastatic tumors, lymphogranuloma venereum, apocrine abscess.
Prevention & Therapy
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.
Prevention
Weight loss and tobacco abstinence, pain management, treatment of secondary infections.
Special
Comorbid disorders: Inflammatory bowel disease, spondylarthropathy, increased cardiovascular risk.
Syndromic hidradenitis suppurativa diseases are rare.
Differential Diagnosis
Podcasts
Tests
- Peripheral circulatory disturbances with signs such as acrocyanosis and cutis marmorata are possible signs of a predisposition for:
- True or false?
- 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?
- Which of the following statements about hidradenitis suppurativa are true?
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