Hidradenitis Suppurativa at an Uncommon Site: A Review of Its Clinical Features, Diagnostic Difficulties, and Management

Abstract

Hidradenitis suppurativa (HS) is a non-contagious chronic inflammatory and often debilitating skin disease that is characterized by recurrent painful nodules, draining sinus tracts, and abscesses. The disease primarily affects the axillary, perineal, inguinal, intermammary, and inframammary regions with an estimated global prevalence rate of up to 4%. The etiology of HS is still unknown, but our understanding of its pathogenic process has evolved. Once thought to be an infectious process of the apocrine gland, HS is now considered a disease of follicular occlusion. This study aimed to discuss hidradenitis suppurativa in an uncommon site and review the clinical features, diagnostic difficulties, and management of the condition. A PubMed literature search for case reports was done using the medical subject heading (MeSH) term hidradenitis suppurative. Only reports in the last five years that were published in English were considered. The patient underwent a surgical incision and drainage of the deep neck abscesses. The patient continued to be monitored by ENT and was compared to other cases reported in this study. HS mostly presents in the axillary, perineal, inguinal, and gluteal regions. This is a case report of HS in the neck region which is a rare location. After surgical intervention, the patient required prolonged antibiotic therapy for the resolution of symptoms. The diagnosis of HS is made clinically and is based on typical lesions, location, and chronicity. However, phenotypic variation makes diagnosis and severity assessment difficult. Furthermore, a diagnostic delay is evident partly due to early lesions of HS mimicking other skin conditions. CT scans and ultrasounds are emerging as important diagnostic tools, especially in the case of deep-seated lesions. Multiple comorbidities are associated with HS and persistent hidradenitis suppurativa often results in complications. The recurrent nature of HS as well as the lack of curative therapies makes the treatment of the disease challenging.

Keywords: abscess; acne inversa; fistula; hidradenitis suppurativa; sinus tracts and tunnels.