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Hidradenitis suppurativa

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Hidradenitis suppurativa (also known as Verneuil's disease or acne inverse) is a deep-seated inflammatory condition that produces lesions which mainly occur in the axillae, groins and anogenital areas of the body (1).

Hidradenitis is primarily an acne-like follicular occlusion disease where apocrine glands only become involved in the context of peri-follicular inflammation - it is not a primary disease of apocrine glands (1,2).

The disease can be seen after puberty and most commonly in the second or third decade of life (2). This has led to the hypothesis that hormones play a role in the pathogenesis of the disease (1).

Friction from axillary adiposity, sweat, heat, stress, tight clothing, genetic and hormonal components has been recognized as contributory factors (1).

British Association of Dermatologists (BAD) guidelines state that a triad of "typical lesions, in characteristic locations, with a recurrent pattern" is required for diagnosis (3)

  • specifically, two typical lesions (defined as inflamed nodules or abscesses) in typical locations (armpits, submammary, abdominal fold, groin, genital, neck, or perianal areas) over six months or a history of at least five such lesions over a lifetime

Click here for example images of this condition

Refer to dermatology when patients have severe disease or when mild to moderate disease has not responded to first-line treatment with tetracyclines in primary care (3)

Notes:

  • smoking and Hidradenitis suppuritiva
    • a study found quitting smoking linked to lowered risk of hidradenitis suppurativa onset vs continuous smoking; whilst those who initially quit but resumed & those with no previous SM history but started, had similar risks of Hidradenitis suppuritiva onset as sustained smokers (4)

Reference:

  1. Shah N. Hidradenitis Suppurativa: A Treatment Challenge. AFP 2005;72(8)
  2. Sohail N et al. Photo Quiz Chronic, Draining Perianal Sinuses. AFP 2006;74(12)
  3. Hasan S B, Harris C, Collier F. Hidradenitis suppurativa BMJ 2022; 379 :e068383 doi:10.1136/bmj-2021-068383
  4. Kim SR, Choi Y, Jo SJ. Smoking Cessation and Risk of Hidradenitis Suppurativa Development. JAMA Dermatol. Published online August 21, 2024.

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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