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Hidradenitis Suppurativa

Definition

Chronic relapsing inflammatory disorder involving one or more apocrine gland-bearing areas.

Clinical Features

Histopathology26

  • Early lesions:
    • folliculitis and perifolliculitis of lower part of follicle27
    • infundibulum:
      • usually dilated
      • contains:
        • keratinous material
        • inflammatory debris28
  • Established lesions:
    • heavy, mixed inflammatory cell infiltrate in lower half of dermis:
      • usually extension into subcutis29
  • Active cases:
    • chronic abscesses:
      • may connect with sinus tracts:
        • lead to skin surface (Fig. 1
          Hidradenitis suppurativa. There is acute and chronic inflammation in the dermis and an epithelial downgrowth (probably of follicular origin) ‘draining’ the area. There is hemorrhage at the deep edge. (H&E)

          Fig. 1: Hidradenitis suppurativa. There is acute and chronic inflammation in the dermis and an epithelial downgrowth (probably of follicular origin) ‘draining’ the area. There is hemorrhage at the deep edge. (H&E)

          )
        • usually lined by stratified squamous epithelium in outer part
        • contain inflammatory and other debris30
        • some probably residual follicular structures31,32
  • May be:
  • Usually extensive fibrosis with destruction of:
    • pilosebaceous follicles
    • apocrine and eccrine glands

Differential Diagnosis

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References

1 von der Werth JM, Jemec GBE. Morbidity in patients with hidradenitis suppurativa. Br J Dermatol. 2001;144:809–813.

2 Jemec GBE. The symptomatology of hidradenitis suppurativa in women. Br J Dermatol. 1988;119:345–350.

3 Watson JD. Hidradenitis suppurativa – a clinical review. Br J Plast Surg. 1985;38:567–569.

4 Broadwater JR, Bryant RL, Petrino RA, et al.. Advanced hidradenitis suppurativa. Review of surgical treatment in 23 patients. Am J Surg. 1982;144:668–670.

5 Fearfield LA, Staughton RCD. Severe vulval apocrine acne successfully treated with prednisolone and isotretinoin. Clin Exp Dermatol. 1999;24:189–192.

6 Jansen T, Plewig G. Acne inversa. Int J Dermatol. 1998;37:96–100.

7 Endo Y, Tamura A, Ishikawa O, Miyachi Y. Perianal hidradenitis suppurativa: early surgical treatment gives good results in chronic or recurrent cases. Br J Dermatol. 1998;139:906–910.

8 von der Werth JM, Williams HC. The natural history of hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2000;14:389–392.

9 Jemec GBE. Effect of localized surgical excisions in hidradenitis suppurativa. J Am Acad Dermatol. 1988;18:1103–1107.

10 Jemec GBE, Heidenheim M, Nielsen NH. The prevalence of hidradenitis suppurativa and its potential precursor lesions. J Am Acad Dermatol. 1996;35:191–194.

11 Fitzsimmons JS, Guilbert PR, Fitzsimmons EM. Evidence of genetic factors in hidradenitis suppurativa. Br J Dermatol. 1985;113:1–8.

12 Fitzsimmons JS, Guilbert PR. A family study of hidradenitis suppurativa. J Med Genet. 1985;22:367–373.

13 von der Werth JM, Williams HC, Raeburn JA. The clinical genetics of hidradenitis suppurativa revisited. Br J Dermatol. 2000;142:947–953.

14 Mengesha YM, Holcombe TC, Hansen RC. Prepubertal hidradenitis suppurativa: two case reports and review of the literature. Pediatr Dermatol. 1999;16:292–296.

15 MendonHa H, Rebelo C, Fernandes A, et al.. Squamous cell carcinoma arising in hidradenitis suppurativa. J Dermatol Surg Oncol. 1991;17:830–832.

16 Anstey AV, Wilkinson JD, Lord P. Squamous cell carcinoma complicating hidradenitis suppurativa. Br J Dermatol. 1990;123:527–531.

17 Dufresne RG, Ratz JL, Bergfeld WF, Roenigk RK. Squamous cell carcinoma arising from the follicular occlusion triad. J Am Acad Dermatol. 1996;35:475–477.

18 Lapins J, Ye W, NyrJn O, Emtestam L. Incidence of cancer among patients with hidradenitis suppurativa. Arch Dermatol. 2001;137:730–734.

19 Gupta AK, Knowles SR, Gupta MA, et al.. Lithium therapy associated with hidradenitis suppurativa: case report and a review of the dermatologic side effects of lithium. J Am Acad Dermatol. 1995;32:382–386.

20 Li M, Hunt MJ, Commens CA. Hidradenitis suppurativa, Dowling Degos disease and perianal squamous cell carcinoma. Australas J Dermatol. 1997;38:209–211.

21 K'nig A, Lehmann C, Rompel R, Happle R. Cigarette smoking as a triggering factor of hidradenitis suppurativa. Dermatology. 1999;198:261–264.

22 Jemec GBE. What's new in hidradenitis suppurativa?. J Eur Acad Dermatol Venereol. 2000;14:340–341.

23 Ostlere LS, Langtry JAA, Mortimer PS, Staughton RCD. Hidradenitis suppurativa in Crohn's disease. Br J Dermatol. 1991;125:384–386.

24 Attanoos RL, Appleton MAC, Hughes LE, et al.. Granulomatous hidradenitis suppurativa and cutaneous Crohn's disease. Histopathology. 1993;23:111–115.

25 Jansen T, Plewig G. What's new in acne inversa (alias hidradenitis suppurativa)?. J Eur Acad Dermatol Venereol. 2000;14:342–343.

26 Jemec GBE, Hansen U. Histology of hidradenitis suppurativa. J Am Acad Dermatol. 1996;34:994–999.

27 Jemec GBE, Gniadecka M. Ultrasound examination of hair follicles in hidradenitis suppurativa. Arch Dermatol. 1997;133:967–970.

28 Boer J, Weltevreden EF. Hidradenitis suppurativa or acne inversa: A clinicopathological study of early lesions. Br J Dermatol. 1996;135:721–725.

29 Thomas R, Barnhill D, Bibro M, Hoskins W. Hidradenitis suppurativa: a case presentation and review of the literature. Obstet Gynecol. 1985;66:592–595.

30 Hyland CH, Kheir SM. Follicular occlusion disease with elimination of abnormal elastic tissue. Arch Dermatol. 1980;116:925–928.

31 Yu CC-W, Cook MG. Hidradenitis suppurativa: a disease of follicular epithelium, rather than apocrine glands. Br J Dermatol. 1990;122:763–769.

32 Kurzen H, Jung EG, Hartschuh W, et al.. Forms of epithelial differentiation of draining sinus in acne inversa (hidradenitis suppurativa). Br J Dermatol. 1999;141:231–239.

33 Jemec GBE, Hansen U. Histology of hidradenitis suppurativa. J Am Acad Dermatol. 1996;34:994–999.

34 Attanoos RL, Appleton MAC, Douglas-Jones AG. The pathogenesis of hidradenitis suppurativa: a closer look at apocrine and apoeccrine glands. Br J Dermatol. 1995;133:254–258.

Last updated: 26 Nov 2006

Hidradenitis Suppurativa

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