Hidradenitis :: Causes and clinical features of hidradenitis suppurativa

Hidradenitis suppurativa is a deep-seated inflammatory condition that produces lesions which mainly occur in the axillae and groins. Hidradenitis is primarily an acne-like follicular occlusion disease where apocrine glands only become involved in the context of peri-follicular inflammation – it is not a primary disease of apocrine glands.

HS presents itself in three stages:

a few minor sites with rare inflammation; may be mistaken for acne.

frequent inflammations restrict movement and require minor surgery.

inflammation of sites to the size of golf balls, or sometimes baseballs; scarring develops, including subcutaneous tracts of infection. Obviously, patients at this stage may be unable to function.

Causes

As this disease is poorly studied, the causes are controvertial and experts disagree. However, potential indicators include:

post-pubescent
females are more likely than males
genetic predisposition
plugged sweat gland or hair follicle
excessive sweating
bacterial infection
linked to some immunodeficiency conditions
androgen dysfunction

Presentation:

more common in women – affects women 2-5x more than men; average age of onset 23 years of age

most commonly affects the groins and axillae – less often affects the perianal region, inframammary region, suprapubic region or in the abdominal folds

typical lesion is a painful inflammatory nodule, papule or abscess. Sometimes comedomes or dermal contractures can occur. Up to 1/3 of all boils remain blind and fail to discharge.