The Exchange

Commentary and Observations from
the Medical Front Lines

Hidradenitis suppurativa

Hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a chronic, debilitating, inflammatory disease of the hair follicle that usually develops after puberty. It presents with painful inflammatory nodules, abscesses, comedones, scarring, and tunneling sinus tractsmost commonly occurring in the intertriginous areas of the body. While the exact pathogenesis remains unclear, evidence suggests that hair follicles become plugged with keratin, rupture, and leak contents into connective tissue. This is followed by an inflammatory response fueled by tumor necrosis factor alpha and other proinflammatory cytokines.

The estimated prevalence of HS is between 1% and 4% of the general population. It is more common in females and African Americans, with an average age of onset in the early 20s but can start as early as adolescence. HS is often misdiagnosed, resulting in an average delay in diagnosis of 7 to 10 years, which is thought to occur due to a lack of disease awareness. It is important to understand that HS is not a primary skin infection and that the role of bacteria in HS is unclear. Although the first clinical aspects mimic bacterial folliculitis, results of classic bacterial cultures are often negative. It is also important to remember that HS is not contagious, and is not caused by poor hygiene, poor nutrition, or being overweight.

Long-standing, uncontrolled disease can lead to a wide array of complications. Fibrosis and scarring of the skin can occur, especially with axillary disease, which can lead to contractures and impaired mobility. Psychosocial sequelae of HS include decreased quality of life and work productivity, sexual disturbances, depression, and social isolation. As practitioners, it is important to be familiar with the signs, symptoms, pathophysiology, and treatment options available for HS. Timely diagnosis and aggressive treatment with the proper modalities are warranted to gain control over this debilitating disease and allow our patients to regain their quality of life.

  • Alikhan A, Sayed C, Alavia A, et al. North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations. J Am Acad Dermatol. 2019;81:76-90.
  • American Academy of Dermatology. Hidradenitis suppurativa: Overview. Accessed February 17, 2020.
  • Hidradenitis Suppurativa Foundation, Inc. What is hidradenitis suppurtiva? Accessed February 17, 2020.
  • Woodruff CM, Charlie AM, Leslie KS. Hidradenitis suppurativa. A guide for the practicing clinician. Mayo Clin Proc. 2015;90:1679-1693.

Share this page:

Filed under: Dermatology

Development Widget