Can hidradenitis suppurativa (HS) occur on the scrotum?

Hidradenitis Suppurativa Can Occur on the Scrotum

Yes, hidradenitis suppurativa (HS) can definitely occur on the scrotum, as the scrotum is considered part of the anogenital region which is one of the typical sites affected by this chronic inflammatory skin condition. 1

Understanding Hidradenitis Suppurativa

Hidradenitis suppurativa is defined as a chronic, inflammatory, recurrent, debilitating skin follicular disease that typically presents after puberty with painful deep-seated, inflamed lesions in areas with apocrine gland-bearing skin. 1

The most commonly affected areas include:

• Axillae (armpits) 1
• Inguinal region (groin) 1
• Anogenital region (including scrotum in males) 1
• Perineal region 1
• Perianal region 1
• Infra- and intermammary folds 1
• Buttocks 1

Clinical Presentation of Scrotal HS

When HS affects the scrotum, it typically presents as:

• Painful nodules, abscesses, or inflammatory lesions 1, 2
• Sinus tracts and fistulae in more advanced cases 1, 2
• Chronic discharge (serous, purulent, or blood-stained) 1
• Persistent malodor 1
• Scarring and fibrosis with long-standing disease 1, 2

Diagnostic Criteria

The diagnosis of HS, including scrotal involvement, requires:

• Typical lesions (painful nodules, abscesses, sinus tracts, bridged scars, or open comedones) 1
• Occurrence in typical sites (including the anogenital region where the scrotum is located) 1
• Chronicity and recurrence of the disease 1

Severity Assessment

The severity of HS, including scrotal involvement, is commonly assessed using the Hurley staging system:

• Stage I: Single or multiple isolated abscess formation without scarring or sinus tracts 1
• Stage II: Recurrent abscesses with tract formation and scarring, single or multiple widely separated lesions 1
• Stage III: Diffuse or near-diffuse involvement with multiple interconnected tracts and abscesses 1

Differential Diagnosis

When evaluating scrotal lesions, it's important to distinguish HS from other conditions:

• Fournier gangrene (a more acute, rapidly progressive infection) 1
• Folliculitis (more superficial, less chronic) 3
• Pilonidal disease (more commonly affects the sacrococcygeal region but can present similarly) 1
• Pyoderma gangrenosum (can coexist with HS) 1

Management Considerations for Scrotal HS

Treatment of scrotal HS follows the general principles of HS management but requires special consideration due to the sensitive location:

• Medical therapy options include:

  • Topical antiseptics and antibiotics 1
  • Systemic antibiotics (tetracyclines, clindamycin, rifampicin) 1
  • Biologics (adalimumab for moderate-to-severe disease) 1

• Surgical interventions may be necessary for advanced or refractory cases:

  • Incision and drainage for acute abscesses 1
  • Wide excision for chronic, recurrent disease 2
  • Reconstructive procedures may be needed due to scarring 4

Important Considerations

• Scrotal HS can significantly impact quality of life and sexual function 1

• The condition is associated with various comorbidities that should be screened for:

  • Depression and anxiety 1
  • Inflammatory bowel disease, particularly Crohn's disease 1
  • Spondyloarthritis 1
  • Cardiovascular risk factors 1

• Risk factors that may exacerbate scrotal HS include:

  • Obesity 1
  • Smoking 1
  • Mechanical friction from tight clothing 5

Conclusion

Scrotal involvement in HS is well-documented in the medical literature and should be recognized as part of the disease spectrum. Early diagnosis and appropriate management are crucial to prevent complications and improve quality of life. 1, 2