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INTRODUCTION

KEY POINTS

  • Hidradenitis suppurativa (HS) is a skin disease that may manifest as chronic, recurrent inflammatory nodules, abscesses, scarring, and/or fistulas that are incredibly painful.

  • HS is thought to be more prevalent in individuals of African descent.

  • HS patients report greatly decreased quality of life, and it should be recognized that this disease has not only physical but also social and emotional ramifications.

  • Although primarily considered to be a disease of the skin, patients may be afflicted with a variety of associated systemic complications.

Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory disease of the skin. It typically manifests as painful nodules and abscesses that can progress to form deep sinus tracts, fistulas, and severe scarring. This disease tends to affect areas of the body with apocrine gland–bearing tissue, including the groin, gluteal, axillary, and inframammary regions. For this reason, HS may also be referred to as acne inversa. HS lesions may chronically drain malodorous fluid, which can leave affected individuals uncomfortable and self-conscious. Cultures of fluid draining from HS lesions are classically described as being sterile, but a recent study demonstrated that cultures of deeper tissues following ablation of involved areas with a carbon dioxide laser were positive for coagulase-negative staphylococci, Corynebacterium, and α-hemolytic streptococci.1 Pain from active lesions or restricted movement due to scarring can debilitate those affected. The pathogenesis of this disease process is not fully understood, and it can be quite difficult to treat. Inadequate treatments and incomplete comprehension of the disease process can leave both patients and physicians frustrated. Studies demonstrate that patients with this condition consistently report a significantly decreased quality of life,2,3,4,5,6 even when compared with other conditions, such as psoriasis or atopic dermatitis, which are known to decrease quality of life.2,6

HISTORY

The first known descriptions and investigations into HS are attributed to the nineteenth century contemporary French physicians Velpeau, who is credited with first reporting a patient with this condition, and Verneuil, who later published several articles7,8 providing the first conceptualization of this disease process as a discrete entity.9 Because Verneuil was the first to study this disease in depth, HS is often called Verneuil disease. Due to the anatomic distribution of the disease, Verneuil believed that HS was associated with pathology of sweat glands. The disease has been frequently confused with simple infection of the skin, and its history is burdened with misunderstanding of HS as being an issue of inadequate personal hygiene and resulting misdiagnoses. Until the late twentieth century, even when recognized appropriately as HS, physicians continued to hypothesize that the disorder was associated with apocrine gland pathology.10 In the 1990s, histologic studies helped show that the disease process likely emanates from the pilosebaceous unit rather than the apocrine glands.11

Epidemiology

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