Review article
Hidradenitis suppurativa

https://doi.org/10.1016/S0039-6109(02)00060-9Get rights and content

Section snippets

Pathogenesis

This disease was first documented in 1839 by Velpeau, who described a patient with an inflammatory process affecting the skin of the axillary, mammary, and perianal regions [3]. It was not until 1854, however, that it was suggested by Verneuil that the disease originated in the sweat glands [4]. In 1922, Schiefferdecker further classified sweat glands as apocrine or eccrine, and localized this disorder to the apocrine glands [5]. The histology was defined in 1939 by Brunsting, who suggested

Bacteriology

The bacterial flora involved in hidradenitis is inconsistent and unpredictable. Wounds in patients with positive cultures have grown bacteria such as Staphylococcus epidermidis, Escherichia coli, Klebsiella, Proteus, alpha Streptococcus, anaerobic bacteria, and diptheroids [8]. Thornton and Abcarian, however, found that half of their patients treated for perianal and perineal disease had negative cultures [10]. Highet and colleagues associated Streptococcus milleri infection with perineal

Etiology

The underlying reason for apocrine or follicular occlusion remains uncertain, though several predisposing factors have been suggested. Histologic studies have not demonstrated a difference in glandular structure to account for susceptibility to the disease [7]. Although the use of antiperspirants may prevent discharge of apocrine gland secretions and predispose the development of hidradenitis, Morgan and Leicester found no significant differences in shaving practices, deodorant usage, and

Incidence

The incidence of hidradenitis in the general population is unknown, mainly secondary to under reporting and misdiagnosis. However, it has been estimated that 1 in 300 adults is affected, usually presenting after puberty and before the age of forty [22]. Hidradenitis may be more common in females and blacks [25], [26], but perianal disease appears to be twice as common in males as in females [9], [13].

Clinical presentation

Any region of the body harboring apocrine glands may be involved, but the axillary and inguinal-perineal regions are most commonly affected [14]. Initially, patients will experience pain and present with indurated, deep subcutaneous nodules that organize as abscesses and may start spontaneously draining malodorous discharge. The wound usually does not heal completely, and recurrences are common. With each recurrence, the subcutaneous cavities tend to grow larger. The final result is an

Diagnosis

Differentiating hidradenitis from other cutaneous infections such as furuncles, carbuncles, lymphogranuloma venereum, erysipelas, epidermoid or dermoid cysts, and tuberculosis can be difficult [13], [27]. Perianal hidradenitis must be distinguished from other perianal pathology that can mimic its presentation. Cryptoglandular fistulae, for example, arise from the dentate line and involve the intersphincteric plane, whereas the tracts from hidradenitis do not involve the sphincter mechanism.

Treatment

Hidradenitis suppurativa presents as a spectrum of disease, ranging from mild, localized disease to extensive skin involvement in multiple affected areas. Treatment should be prioritized, with the most severe sites addressed first.

Summary

Hidradenitis suppurativa is a chronic, debilitating disease of apocrine gland-bearing skin. Its management must be individualized according to the site and extent of the disease. Initial conservative measures with antibiotics, local wound care, and limited incision and drainage can alleviate the acute symptoms, but more radical surgery will likely eventually be necessary in order to control and prevent recurrent disease. Options include unroofing and marsupialization, local excision, or more

First page preview

First page preview
Click to open first page preview
View PDF

References (54)

  • A. Vernuil

    De l'hidrosadenite phlegmoneuse et des absces sudoripares

    Arch Gen Med Paris

    (1864)
  • P. Schiefferdecker

    Die Hautdrusen des Menschen, und der Saugetiere, ihre Biologische und rassenanatomische Bedeutung Sowie die Muscularis Sexualis

    (1922)
  • H.A. Brunsting

    Hidradenitis suppurativa: abscess of the apocrine sweat glands

    Arch Derm Syphil

    (1939)
  • W.P. Morgan et al.

    The distribution, size and density of the apocrine glands in hidradenitis suppurativa

    Br J Surg

    (1979)
  • A.S. Highet et al.

    Bacteriology and antibiotic treatment of perineal suppurative hidradenitis

    Arch Dermatol

    (1988)
  • S.C. Brown et al.

    Surgical treatment of perineal hidradenitis suppurativa with special reference to recognition of the perianal form

    Br J Surg

    (1986)
  • J.P. Thornton et al.

    Surgical treatment of perianal and perineal hidradenitis suppurativa

    Dis Colon Rectum

    (1978)
  • E.J. Baron et al.

    Bilophila wadsworthia isolates from clinical specimens

    J Clin Microbiol

    (1992)
  • J. Bendahan et al.

    The possible role of Chlamydia trachomatis in perineal suppurative hidradenitis

    Eur J Surg

    (1992)
  • O. Wiltz et al.

    Perianal hidradenitis suppurativa. The Lahey Clinic experience

    Dis Colon Rectum

    (1990)
  • B.J. Harrison et al.

    Hidradenitis suppurativa: evidence for an endocrine abnormality

    Br J Surg

    (1985)
  • A.J. Stellon et al.

    Hidradenitis suppurativa associated with use of oral contraceptives

    BMJ

    (1989)
  • M.R. Keighley et al.
  • R.J.G. Chalmers et al.

    Acne vulgaris and hidradenitis suppurativa as presenting features of acromegaly

    BMJ

    (1983)
  • A.C. Curtis

    Cushing's syndrome and hidradenitis suppurativa

    Arch Dermatol Syph

    (1950)
  • U.J. Wile et al.

    Cushing's syndrome with hidradenitis suppurativa

    Arch Dermatol Syph

    (1948)
  • J.S. Fitzsimmons et al.

    Familial hidradenitis suppurativa: evidence in favor of single gene transmissions

    J Med Genet

    (1984)

    • Cited by (38)

    • Office-Based Excision for Hidradenitis Suppurativa: A Surgeon’s Decades-Long Experience

      2022, A Comprehensive Guide to Hidradenitis Suppurativa

    • Men, main victims of hidradenitis suppurativa (A prospective cohort study)

      2018, International Journal of Surgery
      Citation Excerpt :

      We used only flaps or grafts or combination of them according to extent of HS. Primary closure was used in moderate Hurley stage II HS defects in axillary, inguinal and perianal regions after wide excision of the diseased areas and elevation and develop of the skin flaps [14,16]. All patients were very satisfied with the functional and aesthetic results.

    • Chapter 2 - Noninfectious Inflammatory Disorders of the Vulva

      2017, Diagnostic Gynecologic and Obstetric Pathology

    • Hurwitz Clinical Pediatric Dermatology, Fouth Edition

      2011, Hurwitz Clinical Pediatric Dermatology, Fouth Edition

    • Biologic drugs for the treatment of hidradenitis suppurativa: An evidence-based review

      2010, Dermatologic Clinics
      Citation Excerpt :

      Weight loss and avoidance of heat and humidity can help reduce maceration and irritation of the affected sites.2,3 Other measures, such as avoidance of shaving affected areas, eliminating tight synthetic clothing, lowering stress, and smoking cessation, have only anecdotally been associated with amelioration of the disease.8,9 Moderate disease is characterized by multiple nodules and abscesses with purulent discharge.3

    • Inflammatory and Neoplastic Disorders of the Anal Canal

      2009, Surgical Pathology of the GI Tract, Liver, Biliary Tract and Pancreas
    View all citing articles on Scopus
    View full text
    Copyright © 2002 Elsevier Science (USA). All rights reserved.