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Hidradenitis suppurativa is a chronic condition that can have a tremendous impact on a patient’s quality of life. In this segment we sit down with Dr. Brittney DeClerck and look at evidence based approaches to helping get these patients some much needed relief.
- Hidradenitis suppurativa (HS) is caused by recurrent inflammation of apocrine sweat glands in the axillae and groin.
- It is most common in overweight, young women.
- HS is not caused by infection, however, draining abscesses can offer immediate relief.
- All patients should be referred to dermatology for more definitive management.
- Weight loss, smoking cessation, and looser fitting clothing can reduce disease severity.
- Hidradenitis suppurativa (HS) is a complex disease with two primary derangements.
- One is a predisposition to having occlusion of the hair follicles.
- The occluded hair follicles tend to rupture beneath the skin triggering a robust inflammatory response.
- HS can cause multiple types of lesions, however, blackheads (comedones) are most often the primary lesions, which represent occluded follicles from retained keratin.
- Over time, the scarring from these lesions will create sinus tracts.
- HS tends to occur most frequently in adolescent/young adult, African American, overweight, women.
- Affects females twice as much as men.
- HS most commonly affects areas of the body with apocrine sweat glands (ie: associated with a hair follicle) such as the axillae, groin, and buttocks.
- Hidradenitis is an inflammatory and NOT an infectious process.
- The abscesses are sterile initially, but can become infected secondarily in some cases.
- History should focus on prior treatments and what has been effective and ineffective.
- I&D can be offered if there is fluctuance.
- I&D is not curative like with infectious abscesses, but offers immediate relief.
- Packing these after drainage is generally not recommended.
- There is no harm in performing I&D’s in patients with HS’s long term course.
- Antibiotics are NOT recommended after I&D unless there is surrounding cellulitis.
- Topical clindamycin is a safe therapy to prescribe from UC to reduce the likelihood of recurrence.
- Dermatologists will often prescribe an oral tetracycline for 4-6 months.
- 1-2 week courses of low dose oral prednisone (~10mg daily) and/or intralesional injections of steroids, such as triamcinolone (5-10mg), can be helpful.
- Intralesional injections should target where the dermis and subcutaneous tissue meet, but should only be performed by providers with training in this procedure.
- Longer term therapies dermatologists may prescribe for this condition include biologic therapies, such as adalimumab.
- Surgical excision of the apocrine gland containing tissues by a plastic surgeon can be curative.
- Patients can reduce the likelihood of recurrence by avoiding heat, tight clothing, sweat, friction, pressure, trauma, shaving in the area, and smoking.
- Weight loss is also helpful for reducing frequency and severity of HS flares.
- Saunte D, Jemec G. Hidradenitis Suppurativa: Advances in Diagnosis and Treatment. JAMA. 2017;318(20):2019‐2032. doi:10.1001/jama.2017.16691
- Lee E, Alhusayen R, et al. What is hidradenitis suppurativa?. Can Fam Physician. 2017;63(2):114‐120.
- Alikhan A. Hidradenitis Suppurativa. JAMA Dermatol. 2016;152(6):736. doi:10.1001/jamadermatol.2016.0185
- Goldburg S, Strober B, et al. Hidradenitis suppurativa: Epidemiology, clinical presentation, and pathogenesis. J Am Acad Dermatol. 2020;82:1045-58.
- Goldburg S, Strober B, et al. Hidradenitis suppurativa: Current and emerging therapies. J Am Acad Dermatol. 2020;82:1061-82.