Hidradenitis Suppurativa Information
Hidradenitis suppurativa is a chronic suppurative and scarring disease of the skin and subcutaneous tissue occurring in the axillae, the anogenital regions, and under the female breast. The disease does not appear until after puberty, and most cases develop in the second and third decades of life. Studies show clustering in families. A familial form with autosomal dominant inheritance has been described.
Hidradenitis suppurativa is now believed to be a disease of the follicle rather than one beginning in the apocrine glands. Like acne, the initial event may be the formation of a keratinous follicular plug.
The plugged structure dilates, ruptures, becomes infected, and progresses to abscess formation, draining, and fistulous tracts. In the chronic state, secondary bacterial infection probably is a major cause of exacerbations.
A hallmark of hidradenitis is the double or bridged comedone, a blackhead with two or sometimes several surface openings that communicate under the skin. This distinctive lesion may be present for years before other symptoms appear.
There is a great variation in clinical severity. Many cases, especially of the thighs and vulva, are mild and misdiagnosed as recurrent furunculosis. The disease is worse in the obese. Those patients who gain weight will often develop lesions between newly formed folds of fat.
The primary lesions are painful red papules and abscesses and inflamed discharging papules or nodules. These heal forming dermal contractures and ropelike elevation of the skin.