suppurativa

Hidradenitis suppurativa, often referred to simply as suppurativa, is a chronic inflammatory skin disease characterized by painful nodules, abscesses, sinus tracts, and scarring in apocrine gland–bearing areas. The most commonly affected sites are the axillae, groin, perineal region, buttocks, and inframammary folds. Lesions recur over years and can coalesce, causing draining sinuses and significant discomfort, infection risk, and psychosocial impact.

Pathophysiology is multifactorial: follicular occlusion with rupture of hair follicles leads to secondary inflammation. Genetic predisposition exists, sometimes with autosomal dominant patterns. Smoking and obesity increase risk; hormonal factors may influence disease activity. Inflammation involves cytokines such as TNF-α, IL-1, and IL-17; a predominantly inflammatory immune response is involved.

Diagnosis is clinical, based on history and exam; Hurley staging is commonly used: Stage I is one or more abscesses without sinus tracts; Stage II involves recurrent abscesses with sinus tracts and scarring, with lesions separated by normal skin; Stage III shows widespread involvement with interconnected sinus tracts. Differential includes boils, folliculitis, and other chronic skin infections.

Management aims to reduce symptoms, prevent flares, and minimize scarring. Lifestyle measures include weight loss and smoking cessation. Treatments range from topical antiseptics and antibiotics for mild disease to systemic antibiotics with anti-inflammatory properties (e.g., doxycycline, minocycline, or clindamycin plus rifampin); anti-inflammatory biologics such as adalimumab for moderate-to-severe disease; hormonal therapies for women; corticosteroids in select cases. Surgical options include incision and drainage for acute abscesses, wide local excision for involved regions, and laser or dermabrasion in selected cases. The disease is chronic with a relapsing course; management is individualized and often requires multidisciplinary care.