European Consensus on Hidradenitis Suppurativa Management

Overview / DefinitionHidradenitis suppurativa (HS) is a chronic, inflammatory skin disorder characterized by recurrent, painful nodules and abscesses in areas rich in apocrine glands, primarily the axillae, groin, and perineum. It is often associated with scarring and can significantly impact a patient's quality of life. EpidemiologyHS has a prevalence estimated between 1% and 4%, with a higher incidence observed in women. The condition typically presents in the late teens to early adulthood, and genetic, environmental, and lifestyle factors are believed to contribute to its development. Gender: More common in females (3:1 ratio). Age of onset: Most commonly between ages 18-24. Associations: Higher prevalence in patients with obesity, metabolic syndrome, and smoking. Pathophysiology / MechanismThe exact pathophysiology of HS remains unclear, but it is thought to involve a combination of genetic predisposition, immune dysregulation, and follicular occlusion. The inflammatory process leads to the formation of painful nodules, abscesses, and sinus tracts. Genetic factors: Mutations in the ABCC11 gene have been implicated. Immune response: Dysregulated T-cell responses and increased levels of pro-inflammatory cytokines. Follicular occlusion: Blockage of hair follicles leading to inflammation and infection. Clinical PresentationPatients with HS typically present with painful, recurrent nodules and abscesses in intertriginous areas. These may drain purulent material and can lead to scarring and sinus tract formation. Stages of HS: Stage I: Single or multiple abscesses without scarring. Stage II: Recurrent abscesses with sinus tracts and scarring. Stage III: Multiple interconnected sinus tracts and extensive scarring. Symptoms: Pain, swelling, and drainage of pus. Location: Common sites include axillae, groin, buttocks, and breast. Diagnosis / WorkupThe diagnosis of HS is primarily clinical, based on the characteristic presentation. A thorough history and physical examinat