Update December 1, 2018




Hidradenitis suppurativa is a chronic inflammatory disease presenting as painful subcutaneous nodules.

Patients experience appreciable physical, psychological, and economical hardship and decreased quality of life.

It is characterized by multiple abscesses, internetworking sinus tracts, foul-smelling exudate from draining sinuses, inflammation in the dermis, both atrophic and hypertrophic scars, ulceration, and infection, which may extend deep into the fascia.

Affected sites are axillary, ­inguinal, perineal, mammary, and inframammary areas corresponding to a “milk-line” distribution.


The current pathophysiologic mechanism is that there is follicular occlusion, and not an apocrine disorder as previously believed.

Hyperandrogenism does not have a proven role in the disease; poor hygiene, smoking, alcohol consumption, and bacterial involvement are thought to exacerbate rather than initiate the disease process.

Treatment varies depending on disease severity and extent.

The majority of patients with early-stage disease (abscesses without significant scarring) respond to topical or systemic antibiotics (clindamycin is first-line therapy). Antiandrogens have an equivocal role in therapy. Application of various anti-inflammatory agents has been successful in limited accounts and with questionable long-term efficacy. With the goal of ablating hair follicles, radiation therapy, radiofrequency ablation, and carbon dioxide (CO2) laser ablation have been employed, again with less than satisfactory long-term results.9,10,11,12

Refractory cases respond best to wide surgical debridement of the affected sites. Recurrence rates tend to be higher in the inframammary and inguino-perineal regions, reaching up to 50%. Primary wound closure after debridement bears a high risk of recurrence and is therefore discouraged. Locoregional flaps, split-thickness skin grafting, and healing by secondary intention are other alternatives. Skin grafting has a faster healing rate compared with secondary wound closure. However, the cost of having a painful donor site and limb immobilization led most patients in one reported study to prefer secondary healing.13 Topical antimicrobial creams should be used during the healing process.


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