Hidradenitis suppurativa: A comprehensive review

Hidradenitis suppurativa, also known as acne inversa, is a chronic, often debilitating disease primarily affecting the axillae, perineum, and inframammary regions. Prevalence rates of up to 4% have been estimated. Our understanding of the disease has changed over time. It is now considered a disease of follicular occlusion rather than an inflammatory or infectious process of the apocrine glands. Clinically, the disease often presents with tender subcutaneous nodules beginning around puberty. The nodules may spontaneously rupture or coalesce, forming painful, deep dermal abscesses. Eventually, fibrosis and the formation of extensive sinus tracts may result. The location of the lesions may lead to social embarrassment and the failure to seek medical treatment. Therapies in the past have consisted of long-term antibiotics, antiandrogens, and surgery. New treatments like tumor necrosis factor–alfa inhibitors have given clinicians more options against this difficult disease.

Learning objectives

After completing this learning activity, participants should be able to describe the clinical presentation, demographics, and prevalence of hidradenitis suppurativa, be familiar with current controversies regarding the pathogenesis of this complex, and be able to discuss potential treatments and their outcomes.

Key words: acne inversa, etanercept, hidradenitis suppurativa, infliximab, Verneuil disease

Abbreviations: AD, autosomal dominant, CD, Crohn disease, CNS, coagulase-negative Staphylococcus, DDD, Dowling–Degos disease, DLQI, Dermatology Life Quality Index, FFD, Fox–Fordyce disease, HS, hidradenitis suppurativa, IK, interstitial keratitis, KID, keratitis-icthyosis-deafness, OC, oral contraceptive, SAPHO, synovitis, acne, pustulosis, hyperostosis, and osteitis, SCC, squamous cell carcinoma, TLR, Toll-like receptor, TNF, tumor necrosis factor