Hidradenitis Suppurativa: A Clinician’s Tool for Early Diagnosis and Treatment
Monica A. Beshara

Journal of the Dermatology Nurses' Association
February 2012 
Volume 4  Number 1
Pages 50 - 53
  PDF Version Available!

Hidradenitis suppurativa (HS) is a chronic and relapsing condition occurring in areas that contain apocrine sweat glands, usually the axillae and groin. This disease is sometimes associated with severe cystic acne and pilonidal sinuses (follicular occlusion syndrome). Comedone-like follicular occlusion, chronic relapsing inflammation, mucopurulent discharge, and progressive scarring characterize HS lesions.1-6HS affects more women than men, and it can be very painful and disfiguring. NPs should be familiar with HS and understand the diagnostic process and treatments to provide the best outcomes for patients.HS symptoms were first described in 1839 by Velpeau when a patient presented with superficial abscesses in the axillary, breast, and perianal regions. In 1854, Verneuil associated the condition with the apocrine glands, and the condition was given its current name, although for many years, the process was referred to as Verneuil disease.6,7The prevalence of HS is approximately 1% to 2% of the general population.6,8 Although it is seen in individuals worldwide, hot, humid environments tend to support its development. HS affects all races; however, severe cases are most often seen in people with black skin, possibly because they may have more apocrine glands than other races.4,6 Males have a higher incidence of anogenital involvement, whereas females experience higher axillary involvement. HS can present anytime between puberty and postmenopause, and the onset of HS peaks in individuals between the ages of 11 and 50 years old.Predisposing factors include obesity, smoking, genetic predisposition to acne, apocrine duct obstruction, and secondary bacterial infection.3,5 Because apocrine glandsare stimulated by androgen and suppressed by estrogen, symptoms are often worse during the menstrual period and decrease after menopause. This may also explain the common findings of hirsutism and obesity in affected women.6,9-11Heredity may play a role in the predisposition to HS

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