hidradenitis

Hidradenitis, commonly referred to as hidradenitis suppurativa, is a chronic inflammatory skin condition characterized by recurrent, painful nodules and abscesses in apocrine-gland–bearing areas such as the axillae, groin, perineal region, inframammary folds, and buttocks. It typically begins after puberty and follows a relapsing course with flare-ups and remissions. The condition is more common in women and is associated with obesity and tobacco use; genetic factors may also play a role, including familial cases linked to mutations in components of the gamma-secretase complex.

Pathophysiology involves follicular occlusion and rupture of the hair follicle, followed by an inflammatory response that can lead to sinus tract formation and scarring. The disease is not primarily an infection, though secondary bacterial colonization can occur during flares.

Diagnosis is clinical, based on the pattern and distribution of lesions. Differential diagnoses include boils, bacterial abscesses, epidermoid cysts, pilonidal disease, and Crohn’s disease–related perianal involvement.

Treatment is individualized and ranges from lifestyle modifications to medical and surgical interventions. Medical approaches include topical antiseptics and antibiotics for anti-inflammatory or antimicrobial effects, hormonal therapy in selected patients, and biologic agents such as tumor necrosis factor inhibitors (notably adalimumab) for moderate to severe disease. Retinoids and other systemic therapies may be used in some cases. Surgical options, including drainage and wide local excision of chronic sinus tracts, are employed for refractory disease. Early recognition and multidisciplinary care can improve outcomes and quality of life.