II. Epidemiology

  1. More common in women by a factor of 4:1
  2. Onset between Puberty and age 40 years

III. Pathophysiology

  1. Inflammation of the Apocrine Sweat Glands

IV. Risk Factors

  1. Obesity
  2. Genetic predisposition to Acne Vulgaris
  3. Family History of Hidradenitis Suppurativa
  4. Apocrine duct obstruction
  5. Secondary Bacterial Infection
  6. Symptomatic flares often occur during Menses

V. Symptoms

  1. Pain, itching, burning and erythema in area involved

VI. Signs

  1. Characteristic
    1. Early: Inflammatory Nodule or abscess
    2. Later
      1. Sinus tract formation
      2. Fibrosis
      3. Bridge scarring
      4. Hypertrophic Scar or Keloid
      5. Contractures
      6. Comedones
  2. Distribution
    1. Axilla (more common in women)
    2. Anogenital area (more common in men)
    3. Breasts
    4. Extension onto back and buttocks

IX. Management: Mild (Single Nodules with minimal pain)

  1. Avoid exposure to heat and humidity
  2. Avoid shaving if it causes irritation
  3. Avoid synthetic tight fitting clothes
  4. Use antibacterial soaps or hibiclens
  5. Weight loss
  6. Apply warm compresses to affected area

X. Management: Moderate (Recurrent Nodules, pain, abscesses)

  1. Antibiotics for 2 months or more
    1. Axillary involvement
      1. Dicloxacillin
      2. Erythromycin
      3. Tetracycline
      4. Clindamycin Topically (Cleocin-T)
    2. Anogenital involvement
      1. Augmentin or other broad spectrum antibiotic
  2. Other options
    1. Oral Contraceptives (high Estrogen, low androgen)
      1. See Androgenic Activity
    2. Accutane 0.5 to 1 mg/kg PO daily
      1. Used before surgery
    3. Corticosteroids (variable efficacy)
      1. Prednisone 70 mg tapered over 14 days
      2. Intralesional triamcinolone
    4. Cryotherapy

XI. Management: Late (abscesses, sinuses, scarring)

  1. Referral to Dermatology
  2. Extensive surgical excision of lesions

XII. Complications

  1. Rectal or Urethral fistulas
  2. Secondary infection
  3. Lymphedema
  4. Squamous Cell Carcinoma

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Ontology: Hidradenitis (C0085160)

Definition (CHV) inflammation of sweat glands
Definition (CHV) inflammation of sweat glands
Definition (CHV) inflammation of sweat glands
Definition (NCI) Inflammation of the apocrine sweat glands, characterized by redness, itching, pain or swelling of the sweat glands, usually in the axillae or groin.(NICHD)
Definition (MSH) The inflammation of a sweat gland (usually of the apocrine type). The condition can be idiopathic or occur as a result of or in association with another underlying condition. Neutrophilic eccrine hidradenitis is a relatively rare variant that has been reported in patients undergoing chemotherapy, usually for non-Hodgkin lymphomas or leukemic conditions.
Concepts Disease or Syndrome (T047)
MSH D016575
ICD9 705.83
SnomedCT 267814008, 267866004, 156417004, 201204008, 69741000
English Hidradenitis, Hidrosadenitis, Hydradenitis, Hidradenitides, Hidrosadenitides, Hydradenitides, Sweat gland inflammation, Hidradenitis [Disease/Finding], hidradenitis, Hidradenitis (disorder), hydradenitis, hidrosadenitis
Dutch zweetklierontsteking, hidradenitis, Hidradenitis
French Inflammation des glandes sudoripares, Hidrosadénite, Hidradénite
German Schweissdruesenentzuendung, Hidradenitis, Hidrosadenitis, Schweißdrüsenentzündung
Italian Infiamazione di ghiandola sudoripara, Idradenite, Idrosadenite, Idroadenite
Portuguese Inflamação das glândulas sudoríparas, Hidrosadenite, Hidradenite
Spanish Inflamación de las glándulas sudoríparas, golondrino, hidradenitis, hidrosadenitis (trastorno), hidrosadenitis, Hidradenitis, Hidrosadenitis
Japanese 汗腺の炎症, カンセンエン, カンセンノエンショウ, 好中球性エクリン汗腺炎, エクリン汗腺炎-好中球性, 汗腺炎
Swedish Svettkörtelinflammation
Czech zánět potních žláz, hidradenitida, Hidradenitida, Zánět potní žlázy
Finnish Hikirauhastulehdus
Polish Zapalenie gruczołów potowych zewnątrzwydzielnicze obojętnochłonne, Zapalenie gruczołów potowych neutrofilowe ekrynowe, Zapalenie gruczołów potowych
Hungarian Hidradenitis, Verejték mirigy gyulladás
Norwegian Svettekjertelbetennelse, Hidrosadenitt

Ontology: Hidradenitis Suppurativa (C0162836)

Definition (MSH) A chronic suppurative and cicatricial disease of the apocrine glands occurring chiefly in the axillae in women and in the groin and anal regions in men. It is characterized by poral occlusion with secondary bacterial infection, evolving into abscesses which eventually rupture. As the disease becomes chronic, ulcers appear, sinus tracts enlarge, fistulas develop, and fibrosis and scarring become evident.
Definition (MEDLINEPLUS)

Hidradenitis suppurativa (HS) is a chronic disease of a type of sweat gland. It can occur in one or multiple areas of your body. HS usually develops in your armpits, groin, and anal area. It causes long-term skin inflammation and can be painful.

Symptoms include

  • Blackheads and red, tender bumps, called abscesses. The abscesses get bigger, break open, and leak pus
  • Tunnels that form under the skin between abscesses
  • Scarring

No one knows what causes HS. It is more common in women, African Americans, and people who have had acne. It usually starts after the teenage years. Treatments include antibiotics, anti-inflammatory medicines, and sometimes surgery. Losing weight and wearing loose clothing can help, too.

Concepts Disease or Syndrome (T047)
MSH D017497
ICD10 L73.2
SnomedCT 201204008, 156417004, 267866004, 59393003
English Suppurative Hidradenitis, hidradenitis suppurativa, hidradenitis suppurativa (diagnosis), Hidradenitis Suppurativa, Acne Inversa, Inversa, Acne, Inversas, Acne, Acne Inversas, Hidradenitis Suppurativa [Disease/Finding], axillary hidradenitis, verneuil's disease, axillaries hidradenitis, hidradenitis suppurative, suppurative hidradenitis, suppurativa hidradenitis, apocrine acne, Acne inverse, Suppurative Hidradenitides, Hidradenitis, Suppurative, Hidradenitides, Suppurative, Apocrine acne, Hidradenitis suppurativa, Hidradenitis axillaris, Suppurative hidradenitis, Verneuil's disease, Hidradenitis suppurativa (disorder)
Swedish Svettkörtelinflammation, varig
Czech hidradenitis suppurativa, potní žlázy - zánět hnisavý, Hidradenitis suppurativa
Finnish Märkivä hikirauhastulehdus
Korean 화농성 땀샘염
Portuguese Acne Inversa, Hidradenite purulenta, Hidradenite Supurativa
Spanish Acné Inversa, Hidradenitis supurativa, Acné Inverso, acné apocrina, enfermedad de Verneuil, hidradenitis axilar, hidradenitis supurativa, hidrosadenitis axilar, hidrosadenitis supurativa (trastorno), hidrosadenitis supurativa, Hidradenitis Supurativa
Dutch hidradenitis suppurativa, Hidradenitis suppurativa
Italian Idrosadenite suppurativa, Idroadenite suppurativa
Japanese カノウセイカンセンエン, 化膿性汗腺炎, 汗腺炎-化膿性
Polish Zapalenie gruczołów potowych ropne
Hungarian Hidradenitis suppurativa
French Hidradenitis Suppurativa, Maladie de Verneuil, Hidradénite suppurée, Hidrosadénite suppurée, Idrosadénite suppurée
German Hidradenitis suppurativa, Schweißdrüsenentzündung, eitrige