Workup
- Definition: blocked apocrine glands in axilla and anogenital regions, plugged follicles rupture into dermis leading to abscesses and sinus tracts, infection appears secondary
- Presentation: inflammatory nodules and sterile abscesses in axillae/inguinal/genital regions, chronic and relapsing
- Hurley classification: abscesses without sinus tracts or scarring (Stage I), recurrent abscesses with sinus tracts or scarring (Stage II), diffuse involvement of multiple interconnecting abscesses (Stage III)
Treatment
- Conservative therapy: smoking cessation, good hygiene, weight loss, minimize friction, DM control
- Pain management: can become chronic issue, avoid narcotics, try NSAIDs (topical), neuromodulators
- Topical agents: clindamycin 0.1% BID x6-8w (does not treat underlying condition), resorcinol 15% x4-6w
- Oral agents: tetracycline 500mg or doxycycline 100mg BID (Stage I), rifampin 300mg BID + clindamycin 300mg BID (Stage II)
- Steroids: intralesional triamcinolone 10 mg/mL, PO prednisolone (10mg/d) x4-6w
- Immune modulators (anti-TNF): adalimumab (80mg qw x2 -> 40mg qw x24), infliximab (7.5-10mg/kg q4w)
- Surgical therapy: I&D only provides temporary relief, surgical excision has low recurrence rates (0%-37%), recurrence associated with degree of excision and not wound coverage (primary intent vs secondary intent vs flap vs STSG)
References
- Anduquia-Garay, Felipe, et al. "Hidradenitis suppurativa: Basic considerations for its approach: A narrative review." Annals of Medicine and Surgery 68 (2021): 102679.
- Link, R. and N. Tang. "Cutaneous Diseases of the External Genitalia." Campbell-Walsh Urology 12 (2020).
- Michel, Chloe, et al. "The treatment of genitoperineal hidradenitis suppurativa: a review of the literature." Urology 124 (2019): 1-5.
- Nesbitt, Emily, Stephanie Clements, and Marcia Driscoll. "A concise clinician’s guide to therapy for hidradenitis suppurativa." International journal of women's dermatology 6.2 (2020): 80-84.