From the Guidelines
Hidradenitis suppurativa (HS) can indeed present as a single lesion, particularly in the early stages of the disease or in mild cases. While HS is typically characterized by multiple inflammatory nodules, abscesses, or sinus tracts in intertriginous areas like the axillae, groin, and buttocks, some patients may initially develop only one lesion. This single lesion often appears as a painful, deep-seated nodule that may progress to form an abscess. According to the North American clinical management guidelines for hidradenitis suppurativa 1, Hurley staging is recommended for determining therapeutic needs, and even a single lesion can be classified as Hurley stage I, characterized by recurrent nodules and abscesses with minimal scar.
The pathophysiology of HS involves follicular occlusion, followed by inflammation and potential secondary bacterial infection, which explains why isolated lesions can occur before the disease becomes more widespread 1. When evaluating a patient with a single inflammatory nodule in an intertriginous area, clinicians should consider HS in the differential diagnosis, especially if there is a history of recurrence at the same site or family history of similar conditions.
Early treatment of even single lesions with appropriate antibiotics (such as clindamycin 1% topical solution or doxycycline 100mg twice daily) 1, incision and drainage if needed, and lifestyle modifications may help prevent disease progression. It is essential to note that HS is fundamentally a chronic, recurrent inflammatory condition that usually evolves to affect multiple sites over time. Therefore, early recognition and treatment of single lesions are crucial to prevent long-term morbidity and improve quality of life.
Some key points to consider in the management of HS include:
- The use of topical clindamycin or resorcinol 15% cream for reducing pustules and inflammation 1
- The importance of pain management and assessment of patient-reported outcomes, such as the Dermatology Life Quality Index (DLQI) and pain visual analog scale scores 1
- The consideration of surgical intervention for patients with extensive scarring or sinus tracts 1
- The need for a holistic, evidence-based approach to the treatment of HS, incorporating medical, surgical, and lifestyle modifications 1
From the Research
HS Lesion Characteristics
- Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by painful, deep-seated nodules, abscesses, and draining tunnels in the skin 2
- The clinical course of HS ranges from relatively mild cases to severe cases demonstrating painful, deep dermal abscesses, fibrosis, draining sinuses, and hypertrophic scars 3
- HS can present with recurrent, inflamed nodules in intertriginous regions, causing intense pain and leading to the formation of fistulas, sinus tracts, and extensive scarring 4
Single Lesion Presentation
- While the provided studies primarily discuss the disease's characteristics and treatment options, they do not explicitly state that HS can only present as a single lesion 5, 3, 2, 4, 6
- However, the studies suggest that HS can have a wide range of clinical presentations, from mild to severe, which may include single or multiple lesions 3, 2, 4
- It is essential to note that the provided evidence does not directly address the question of whether HS can present as a single lesion, but it implies that the disease can manifest in various ways, including potentially as a single lesion 5, 3, 2, 4, 6