Hidradenitis suppurativa (HS) is a common, notoriously challenging disease with truly effective treatments few and far between. While research has led to more effective therapies, the disease continues to cause significant suffering in the 1- 4% of the population affected. An accurate and timely diagnosis is crucial to improve clinical outcomes.
Also known as acne inversa, HS is a chronic inflammatory disease of the terminal follicular epithelium, often occurring in areas rich in apocrine glands. Originally thought to arise from these glands, the condition is now believed to begin through follicular abnormalities.
It may be associated with other follicular-dysfunction processes such as acne, boils in the scalp (folliculitis decalvans) or pilonidal cyst. The process arises in the mid-to-deep dermis and does not seem to be caused by bacterial agents.
It is typically characterized by erythematous, tender, sterile nodules of various sizes that develop insidiously in the inguinal, perianal, submammary, and axillary regions. These nodules may progress to frank abscesses that not only drain to produce a very foul odor but also further develop tunneling, cavitations and sinus tracts in the affected areas, leading to the development of scars and keloids. Rarely, contractures and immobility may result.
Depending on the severity of symptoms, HS will often significantly impact the quality of life of patients, begging the need for more effective treatment regimens and therapeutic options.