Background
HS is a chronic, recurrent, inflammatory skin disease that affects the hair follicles of apocrine sweat glands. Common sites are the axillae and the inguinal and anogenital regions.
HS can be a disabling disorder that relentlessly progresses, frequently causing keloids, contractures, and immobility.
Diagnosis
H&P
Diagnosis is clinical.
-Use the Hurley classification or staging to stage it. Treatment depends on the stage.
Ddx and etiology.
Treatment
-1st-line treatment for stage I is topical clindamycin (10 mg per milliliter twice daily). Alternatives: 1) Gentamicin collagen-sponge, 2) Erythromycin 3% gel.
-2nd-line: Oral antibiotics with anti-inflammatory properties – Doxycycline 100mg BID
-Hibiclens (chlorhexidine topical)
-Hyperbaric oxygen therapy has been effective.
-Smoking cessation.
-Weight loss if overweight or obese.
Other possible treatments
-Intralesional injections of glucocorticoids (e.g., triamcinolone, 2 to 5 mg) for individual lesions.
-Antiandrogens in women
-immunosuppressive agents
-Surgery
You basically treat HS like Acne. Topical antibiotics and systemic antibiotics are used depending on the stage. Also, vitamin A derivatives are used. E.g. Acitretin (Soriatane) is an oral tretinoin just like isotretinoin (Accutane) that is used to treat Hidradenitis Suppurativa as well as Psoriasis.
Pearls
Hidradenitis = Inflammation of the sweat glands.
[G. hidrōs, sweat, + adēn, gland, + -itis, inflammation]
Suppurativa = Suppurative = Forming pus.
-Saw one in the clinic, treated with Dr. Gemma and used Hibiclens and Doxycycline 100mg BID.
References
N Engl J Med 2017; 377:2474. Clinical Diagnosis of Hidradenitis Suppurativa.
N Engl J Med 2012; 366:158-164. Hidradenitis Suppurativa
http://emedicine.medscape.com/article/1073117-medication