Hidradenitis Suppurativa (axilla)

Diagnosis: Hidradenitis Suppurativa (axilla)

Sinuses and scarring result from indolent inflamed papules and nodules in axilla.

Clinical Presentation

Sinuses and scarring result from indolent inflamed papules and nodules in axilla.

Clinical History

Submitted by Alaa Saad. Originally posted November 2, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Furuncle/carbuncle • Crohn disease (cutaneous) • Lymphogranuloma venereum • Cat scratch disease • Pilonidal cyst • Infected epidermal cyst • Actinomycosis

Key Learnings

• Chronic, recurrent, inflammatory disease of apocrine gland-bearing skin • Not primarily an infectious disease — it is an inflammatory condition of follicular occlusion • Part of the follicular occlusion tetrad: HS, acne conglobata, dissecting cellulitis, pilonidal sinus • Hurley staging: I (abscess without tracts), II (recurrent with sinus tracts), III (diffuse involvement) • Smoking and obesity are major modifiable risk factors • Adalimumab is the only FDA-approved biologic for HS • Early diagnosis is critical — average diagnostic delay is 7-10 years

Tags: hidradenitis, suppurativa, axilla, alaa saad