What is Hidradenitis Suppurativa (HS)?

From the Guidelines

Hidradenitis Suppurativa (HS) is a chronic inflammatory skin condition that affects hair follicles in areas where skin rubs together, causing painful, recurrent nodules, abscesses, and tunnels (sinus tracts) in the skin, significantly impacting quality of life through pain, embarrassment, and social isolation. HS typically begins after puberty, is more common in women, and can be triggered by hormonal changes, genetics, smoking, obesity, and mechanical friction 1. The condition progresses through stages, from single recurring abscesses to multiple interconnected tunnels and scarring.

Key Characteristics of HS

• Affects hair follicles in areas where skin rubs together, such as the armpits, groin, buttocks, and under the breasts
• Causes painful, recurrent nodules, abscesses, and tunnels (sinus tracts) in the skin
• Begins after puberty, more common in women
• Triggered by hormonal changes, genetics, smoking, obesity, and mechanical friction

Treatment of HS

Treatment depends on severity and may include:

• Lifestyle modifications (weight loss, smoking cessation)
• Topical antibiotics like clindamycin
• Oral antibiotics such as doxycycline (100mg twice daily) or a combination of clindamycin and rifampin (300mg each twice daily for 10-12 weeks)
• Anti-inflammatory medications
• Hormonal therapy
• Biologics like adalimumab for severe cases
• Surgical interventions ranging from incision and drainage to wide excision of affected areas

Recent Guidelines and Recommendations

Recent guidelines and recommendations for the management of HS emphasize the importance of a multidisciplinary approach, especially in special patient populations, such as those with pregnancy, breastfeeding, pediatrics, malignancy, tuberculosis (TB) infection, hepatitis B or C infection, and HIV disease 1. These guidelines highlight the need for individualized treatment plans and the importance of considering comorbidities and potential interactions with other medications.

Comorbidities and Quality of Life

HS is associated with a high comorbidity burden, and patients with HS are at increased risk of developing other conditions, such as diabetes, cardiovascular disease, and mental health disorders 1. The condition significantly impacts quality of life, causing pain, embarrassment, and social isolation. Therefore, management of HS should prioritize not only the treatment of the condition itself but also the prevention and management of comorbidities and the improvement of quality of life.

From the Research

Definition and Characteristics of Hidradenitis Suppurativa (HS)

• Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent inflammatory nodules mostly located in the armpits and groin 2.
• It is clinically characterized by nodules, bullae, abscesses, fistulae, and draining sinus tracts mainly located in axillae, inguinal folds, inframammary region, and buttocks, often leading to pain, scarring, disfigurement, and decreased quality of life 3.
• HS can have a devastating impact on the quality of life of patients, with symptoms including painful and recurrent nodules and purulent abscesses 4.

Pathogenesis and Treatment

• The pathogenesis of HS remains elusive and is best characterized as multi-factorial, with questions remaining about the role of cutaneous dysbiosis as a primary HS trigger or as a secondary perturbation due to HS inflammation 4.
• Treatment approaches for HS include medical treatments such as clindamycin lotion or resorcinol cream for mild cases, and tetracyclines or the combination of clindamycin and rifampicin for more widespread or severe cases 2.
• Biologics such as infliximab or adalimumab may be used if common treatments have failed, and surgical interventions are often needed to achieve remission 2, 3.
• Novel therapeutic approaches and targets for the treatment of HS are being researched, including the inhibition of specific molecular or cellular targets directly involved in the pathogenesis of the condition 3.

Epidemiology and Complications

• HS usually affects young women, with a prevalence of 0.3% to 4% in industrialized countries 5.
• Potential complications of HS include anemia, arthropathy, and squamous cell carcinoma, and spontaneous resolution is rare, with progressive disability being the rule 5.
• HS may be complicated with other autoinflammatory diseases such as inflammatory bowel diseases and pyoderma gangrenosum, highlighting the importance of autoinflammation in HS 6.