Hidradenitis

Abstract: Background: The morbidity of hidradenitis suppurativa can be considerable, but little is known about its epidemiology. Objective: Our purpose was to describe the 1-year and point prevalences of hidradenitis suppurativa and its potential precursor lesions. Methods: We obtained the histories and examined an unselected sample (599 persons) of the general population (1-year prevalence), and we performed physical examinations for a consecutive sample of 507 persons undergoing screening for sexually transmitted diseases (point prevalence). Results: The point prevalence was 4.1% (95% confidence interval [CI] = 3.0 − 6.0) on the basis of objective findings. The 1-year prevalence of hidradenitis was 1.0% (CI = 0.4 – 2.2) on the basis of subject recollection only. The patients in the sample on which point prevalence is based were younger than those in the unselected sample of the general population ( p p = 0.037), which may result from a female preponderance of genitofemoral lesions (odds ratio [OR] = 5.4; CI=1.5 – 19.3). No sex difference was found in the prevalence of axillary lesions. Conclusion: Hidradenitis suppurativa is significantly more common than hitherto estimated. The female preponderance of patients is confirmed, except for patients with axillary lesions. Additional longitudinal studies are necessary to assess the importance of potential precursor lesions such as noninflamed nodules or comedones.

Abstract: Objective We sought to determine quality of life impairment in hidradenitis suppurativa. Methods Questionnaires were administered to 61 patients. Results Quality of life impact in hidradenitis was much greater than that of several other dermatologic conditions. Limitation This hospital-based population may not be representative. Conclusion Hidradenitis is one of the most distressing conditions observed in dermatology.

Abstract: Background: Antibiotics are often used to treat hidradenitis, but only topical clindamycin has been shown to be effective in a randomized controlled trial. The paucity of these trials may be the result of difficulties in disease assessment. Objective: We compare topical clindamycin with systemic tetracycline in the treatment of hidradenitis suppurativa, and study clinical disease assessment. Methods: A total of 46 patients with stage 1 or 2 hidradenitis suppurativa were treated in a double-blind, double dummy controlled trial. Results: No significant difference was found between the two types of treatment. Patients' global assessment of disease was significantly worse than physician's assessment in 3 of 5 evaluations ( P = .0096 to .015), but the correlation between patients' and physicians' assessments was satisfactory after only one visit (rs = .761 to .895). Soreness was the key factor in patients' overall assessment of the disease. Conclusion: Systemic therapy with tetracyclines did not show better results than topical therapy with clindamycin. Subjective factors, particularly soreness, appear to be a key factor in patients' assessment of the disease and should, therefore, be included as an outcome variable in future therapy studies. (J Am Acad Dermatol 1998;39:971-4.)

Abstract: Hidradenitis suppurativa (HS) is an inflammatory disorder that is characterized by chronic deep-seated nodules, abscesses, fistulae, sinus tracts, and scars in the axilla, inguinal area, submammary folds, and perianal area. This disfiguring condition is accompanied by pain, embarrassment, and a significantly decreased quality of life. Although the mechanism of HS has not been entirely elucidated, lesion formation is believed to center around follicular hyperkeratosis within the pilosebaceous–apocrine unit. Recent research has provided new insight into the role of cytokines in the pathogenesis of HS, helping close some existing knowledge gaps in the development of this condition. The first article in this continuing medical education series reviews HS epidemiology, clinical presentation, and classification. We also provide an update on the most recent understanding of HS pathogenesis, including the central role of inflammatory cytokines and other contributing factors, such as genetics, hormones, and pathogenic microorganisms.