Hidradenitis suppurativa: an update

Abstract

Hidradenitis suppurativa (HS) is a chronic, painful skin disease characterised by recurrent inflammatory lesions in flexural locations such as the axillae, groins and perineum. The papules, nodules and abscesses may discharge blood-stained pus which, combined with pain, results in marked quality-of-life reduction. Sinus tracts and scarring may also result. Onset of HS is typically in the second to fourth decades and it affects about 1% of young European adults. There are links with smoking and obesity and an autosomal dominant pattern of inheritance is reported by one-third of patients. Medical management escalates from topical antimicrobials to oral tetracyclines, a combination of clindamycin and rifampicin typically given for 10 weeks, oral disease modifiers, and anti-tumour necrosis factor-alpha therapies. Excision of individual lesions has high recurrence rates which can be minimised by wider excisions, at the expense of longer healing times. Treatment of pain is a relatively neglected aspect of therapy.

Keywords: Hidradenitis suppurativa; gamma secretase; pain; quality of life.

Fig 1.

Characteristic rope-like scars and sinus formation in the axilla of a person with hidradenitis suppurativa.

Fig 2.

The Hurley staging system. (a) Stage 1 (mild) represents isolated lesions with minimal scarring; (b) stage 2 (moderate) is defined as multiple scarring lesions interspersed with normal skin; and (c) stage 3 (severe) represents coalesced lesions forming inflammatory plaques.