How Is Hidradenitis Suppurativa Treated?
Discussion Hidradenitis suppurativa (HS) is a recurrent, chronic inflammatory disease of the hair follicles particularly in the apocrine gland-bearing areas of the axilla, inguinal, perianal, mammary and inframammary areas. Onset is usually after puberty, in the early 20s. It is more common in females than males. Prevalence is estimated to be 0.05- 4.1%. It can be associated with premature adrenarche, metabolic syndrome and obesity. The lesions are often pruritic, painful, and with malodorous purulent drainage. It often begins with comedomes and tender nodules, and can easily progress to painful abscesses with purulent fluid. HS can also lead to sinus tracts, hypertropic scarring and potentially contractures. Complications include infection, scarring/contractures, lymphedema, and fistula to adjacent structures such as the rectum, bladder or other genitourinary structures. The pain can limit school, work, or activities of daily living including exercise which can also contribute to obesity. HS in the genital area can also cause hygiene and sexual health problems. The differential diagnosis includes follicular pyoderma/furuncles/carbuncles, acne, pilonidal cyst in gluteal area, cat scratch disease, cutaneous tuberculosis, metastasis, and cutaneous Crohn’s disease. Learning Point There is no cure for HS but treatment is guided by the extent of the problem. Consultation with a dermatologist is usually needed as this is a life-long problem. Primary care physicians can as...
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