Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

Hidradenitis Suppurativa 709

■Location in areas with apocrine glands

■Women are more frequently affected.

■Flares are intermittent.

Signs & Symptoms

■Erythematous, fluctuant nodules in areas with apocrine glands

■Multiple patulous follicles may mimic comedones.

■Sinus tracts are common.

■Drainage of serosangineous material and pus

tests

■HS is a clinical diagnosis; there are no confirmatory tests

differential diagnosis

■Includes furunculosis, Crohn’s disease, deep mycoses, scrofulo-

derma, lymphogranuloma venereum, pilonidal sinus

management

What to Do First

■Culture to exclude a treatable infection

General Measures

■Cleansers with antibacterial activity

■Oral antibiotics – generally tetracycline derivatives

■Intralesional injection of triamcinolone acetonide

■Intravenous infliximab or subcutaneous adalimumab have been

reported to be helpful.

■Oral isotretinoin might be useful.

■Other therapies include intralesional botulinum toxin and oral finas-

teride.

■Excision is the only assured method of inducing remission.

specific therapy

■See above

follow-up

■Repeated incision and drainage

■Aggressive surgical exoneration is the only definitive method or erad-

icating the disease.

complications and prognosis

■Pain and scarring

■Chronic inflammation due to sinus tract formation

■With time, the inflammatory reaction subsides.