Hidradenitis Suppurativa (HS)
· Hidradenitis Suppurativa is a chronic inflammatory process that affects the skin and subcutaneous tissue of the axillae, anogenital, and breast regions.
· Severity of disease varies among patients. Pts will present with recurrent tender, subcutaneous, inflammatory nodules or even painful, deep dermal abscesses. Can see fibrosis, draining sinuses/tracts and scarring.
· HS is due to follicular plugging of the apocrine glands followed by a secondary bacterial infection. The classic appearance is a double comedone ( a blackhead with two or more openings that communicate below the skin’s surface). Pt may have these lesions for years without additional symptoms.
· Incidence peaks in the 2nd and 3rd decades (declines by the 5th decade); more common in women than in men (3:1)
· Underlying cause is unknown; however hormonal and genetic etiology is suggested
o Numerous studies show elevation in proinflammatory cytokines (IL-1B, IL-17 and TNF-α)
· Significant associations with:
o Obesity; insulin resistance; metabolic syndrome
o Diagnosis is made clinically
o Widely underdiagnosed consider comorbidities such as actinomycosis, carbuncles, cat scratch disease, crohns, granuloma inguinale, bartholin’s cyst, sebaceous cyst, lymphadenitis, pinonidal sinus, lymphogranuoma venereum, and ulcerative colitis