hidradenitis suppurativa

Last edited 11/2022 and last reviewed 11/2022

Hidradenitis suppurativa (also known as Verneuil's disease or acne inverse) is a deep-seated inflammatory condition that produces lesions which mainly occur in the axillae, groins and anogenital areas of the body (1).

Hidradenitis is primarily an acne-like follicular occlusion disease where apocrine glands only become involved in the context of peri-follicular inflammation - it is not a primary disease of apocrine glands (1,2).

The disease can be seen after puberty and most commonly in the second or third decade of life (2). This has lead to the hypothesis that hormones play a role in the pathogenesis of the disease (1).

Friction from axillary adiposity, sweat, heat, stress, tight clothing, genetic and hormonal components has been recognized as contributory factors (1).

British Association of Dermatologists (BAD) guidelines state that a triad of "typical lesions, in characteristic locations, with a recurrent pattern" is required for diagnosis (3)

  • specifically, two typical lesions (defined as inflamed nodules or abscesses) in typical locations (armpits, submammary, abdominal fold, groin, genital, neck, or perianal areas) over six months or a history of at least five such lesions over a lifetime

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Refer to dermatology when patients have severe disease or when mild to moderate disease has not responded to first line treatment with tetracyclines in primary care (3)