Patients will initially form nodules and sterile abscesses, which then become very tender and painful as they progress into sinus tracts, and then hypertrophic and/or keloidal scarring follows. HS is diagnosed clinically in a setting of appropriate morphology, location, and clinical history. 3 Obesity-related comorbidities including hypertension, dyslipidemia, and polycystic ovary syndrome have been found to be independently associated with higher odds of developing HS, even after adjustment for all other comorbidities. Patients with HS have higher odds of being obese. The majority of associated comorbidities in patients with HS are those seen with metabolic syndrome and obesity. In addition, current or past history of acne vulgaris has not been shown to significantly affect HS severity, 3 and so these conditions should be clinically regarded separately. 2Ī synonym for HS is acne inversa, and although acneiform, deep, and scarring nodules can form, the evidence for an association between acne vulgaris and HS is weak. Interestingly, hormonal associations (and specifically androgen levels and receptors) have not been shown to influence disease development or progression. 1 A hormonal influence on disease has been suspected due to HS onset after puberty and because the disease rarely occurs after menopause in women. HS presents after puberty, with women being affected 3 times more than men. Sterile abscesses form, which may later progress into superinfections with bacterial flora, particularly Staphylococcus spp. This attack leads to follicular rupture, releasing keratin and bacterial flora into the dermis, which further propagates an elevated immune response. The pathophysiology is believed to involve an inflammatory attack on the skin’s hair follicles, with specific targets of apocrine gland-bearing skin.
The inflammation associated with HS presents clinically with recurrent inflamed painful nodules and abscesses, which often lead to both sinus tract and subsequent hypertrophic scar formation.
Hidradenitis suppurativa (HS) is classified as a progressive, inflammatory disease that appears to be primarily caused by inflammation of hair follicles and is most often found in areas of friction of the body, such as the axillae, groin, perineum, and medial thighs.
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