4.1.4 Hidradenitis Suppurativa

Grading & Level of Importance: C




Acne inversa; pyodermia fistulans sinifica.


Prevalence 0.03-4% (average 1%), annual age- and sex-adjusted incidence 6.0 per 100,000. Male:female ratio 1:3. 


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.


Mostly intertriginous occurrence.


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. 


Heterogeneous histological pattern with hyperplasia of hair follicular epithelium and subepidermal and deep cellular inflammatory infiltrate. 


Acute and chronic. 


Squamous cell carcinoma in chronic ano-genital lesions, deep scars, depression, unemployment, change of profession.


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.



Weight loss and tobacco abstinence, pain management, treatment of secondary infections.


Comorbid disorders: Inflammatory bowel disease, spondylarthropathy, increased cardiovascular risk.

Syndromic hidradenitis suppurativa diseases are rare.

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