2. Hidradeni(s Suppura(va
HS is a chronic, recurrent, inflammatory disease
presen(ng as painful subcutaneous nodules
Double comedones, deep sinus tracts, and abscesses are
characteris(c for HS
A diagnosis of HS is made clinically without the use of
laboratory tests
Alikhan A, Lynch PJ, Eisen DB. Suppurativa Suppurativa: A comprehensive review. J Am Acad Dermatol 2009;60:539-61.
4. Clinical Presenta(on
HS mostly typically occurs in the axillary, inguinal,
perianal, perineal, mammary, and inframammary regions
The distribu(on paKern corresponds with the “milk line”
distribu(on of apocrine related mammary (ssue in
mammals
The most commonly affected site is the axilla
Perianal HS is associated with more debilita(ng
outcomes than axillary HS
Alikhan A, Lynch PJ, Eisen DB. Suppurativa Suppurativa: A comprehensive review. J Am Acad Dermatol 2009;60:539-61.
6. Clinical staging
Hurley’s staging system is simple and relies on the
subjec(ve extent of diseased (ssue
The Sartorius system is more sophis(cated then Hurley’s
and is likely to supplant it as a means for conduc(ng
clinical trials
Alikhan A, Lynch PJ, Eisen DB. Suppurativa Suppurativa: A comprehensive review. J Am Acad Dermatol 2009;60:539-61.
7. Hurley Staging System
Stage I abscess formation (single or multiple) without sinus
tracts and cicatrization
Stage II one or more widely separated recurrent abscesses
with tract formation and scars
Stage III multiple interconnected tracts and abscesses
throughout an entire area
Alikhan A, Lynch PJ, Eisen DB. Suppurativa Suppurativa: A comprehensive review. J Am Acad Dermatol 2009;60:539-61.
10. Alikhan A, Lynch PJ, Eisen DB. Suppurativa Suppurativa: A comprehensive review. J Am Acad Dermatol 2009;60:539-61.
11. E(opathogenesis
Long thought to be a disorder of apocrine origin, it is now thought
to be caused by follicular occlusion
Families with autosomal dominance type inheritance have been
reported
Hyperandrogenism likely does not play a role in HS
Bacteria are probably secondary colonizers, which may exacerbate
HS, but they are not the primary e(ologic agents
Poor hygiene does not cause HS
Some inves(gators postulate that there may be an underlying
immunologic aberra(on involved in the pathogenesis of HS; more
work needs to be done in this field before any conclusions can be
made
Smoking and obesity are not primary causes of HS but are strongly
associated with the disease and may exacerbate it
Alikhan A, Lynch PJ, Eisen DB. Suppurativa Suppurativa: A comprehensive review. J Am Acad Dermatol 2009;60:539-61.
14. Psychological and physiologic
morbidity
HS pa(ents experience a quality of life worse than
those with alopecia, mild to moderate psoriasis, and
several other dermatologic condi(ons
HS results in economic and psychological disability in
addi(on to the physical problems
Alikhan A, Lynch PJ, Eisen DB. Suppurativa Suppurativa: A comprehensive review. J Am Acad Dermatol 2009;60:539-61.
15. Disease associa(ons
HS is associated with other diseases of the follicular
occlusion tetrad, acne vulgaris, KID syndrome, IK,
DDD, SAPHO syndrome, CD, Jackson–Lawler type
pachyonychia congenital, reflex sympathe(c
dystrophy, and FFD, among others
Alikhan A, Lynch PJ, Eisen DB. Suppurativa Suppurativa: A comprehensive review. J Am Acad Dermatol 2009;60:539-61.
16. Disease associa(ons
Common associa1ons Rare associa1ons
Acne conglobata Acanthosis nigricans
Acne vulgaris Bazex‐Dupre‐Christol syndrome
Crohn disease Dowling–Degos disease
Dissec(ng celluli(s of the scalp Fox–Fordyce disease
Obesity Inters((al kera((s
Pilonidal disease Kera((s‐ichthyosis‐deafness syndrome
Smoking Pachyonychia congenita
PAPA syndrome
Pyoderma gangrenosum
Reflex sympathe(c dystrophy
SAPHO syndrome
Scrotal elephan(asis
Alikhan A, Lynch PJ, Eisen DB. Suppurativa Suppurativa: A comprehensive review. J Am Acad Dermatol 2009;60:539-61.
18. Complica(ons
Anal, urethral, and rectal strictures and fistulas
Anemia
Contractures and limb mobility limita(ons
Cutaneous squamous cell carcinoma
Increased risk of other malignancy
Lumbosacral epidural abscess
Sacral bacterial osteomyeli(s
Alikhan A, Lynch PJ, Eisen DB. Suppurativa Suppurativa: A comprehensive review. J Am Acad Dermatol 2009;60:539-61.
19. Treatment
There is no uniformly effec(ve single therapy for HS;
therefore, clinicians will likely have to try an array of
different treatment modali(es depending on the
pa(ent's disease
For pa(ents with extensive disease, wide excision can
drama(cally improve the pa(ents' quality of life
Most of the listed therapies are ones that dermatologists
possess in(mate knowledge of and are thus in the best
posi(on to treat this debilita(ng disorder.
Alikhan A, Lynch PJ, Eisen DB. Suppurativa Suppurativa: A comprehensive review. J Am Acad Dermatol 2009;60:539-61.
20. Treatment
An(bio(cs
Re(noids
Hormones
Immunosuppressive and an(inflammatory agents
Neurotoxins
Radiotherapy
Light, radiofrequency, and other procedures
Surgery
Alikhan A, Lynch PJ, Eisen DB. Suppurativa Suppurativa: A comprehensive review. J Am Acad Dermatol 2009;60:539-61.
25. General Treatment Sugges(ons
Avoidance of (ght‐fieng clothing
Nonnarco(c analgesics
Reassurance
Smoking cessa(on
Stress management
Support group referral
Weight loss
Alikhan A, Lynch PJ, Eisen DB. Suppurativa Suppurativa: A comprehensive review. J Am Acad Dermatol 2009;60:539-61.
26. Conclusion
The prevalence of HS may equal or even surpass that of
psoriasis, yet it receives only a frac(on of the aKen(on and
scholarly contribu(ons. Though no overwhelmingly
effec(ve treatments have been described, novel therapies
are emerging
Many—if not all—of these therapies are well known to
dermatologists; therefore, we should play a lead role in
managing this debilita(ng disorder. As our understanding of
this disorder grows, so will our treatment op(ons
Alikhan A, Lynch PJ, Eisen DB. Suppurativa Suppurativa: A comprehensive review. J Am Acad Dermatol 2009;60:539-61.