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Hidradenitis SuppurativaAka: Apocrinitis, Hidradenitis Axillaris, Apocrine Sweat Gland Abscess, Verneuil's Disease, Acne Inversa, Hydradenitis

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  1. Epidemiology
    1. More common in women by a factor of 4:1
    2. Onset between Puberty and age 40 years
  2. Pathophysiology
    1. Inflammation of the Apocrine Sweat Glands
  3. Risk Factors
    1. Obesity
    2. Genetic predisposition to Acne Vulgaris
    3. Family History of hidradenitis suppurativa
    4. Apocrine duct obstruction
    5. Secondary bacterial infection
    6. Symptomatic flares often occur during Menses
  4. Symptoms
    1. Pain, itching, burning and erythema in area involved
  5. Signs
    1. Characteristic
      1. Early: Inflammatory Nodule or abscess
      2. Later
        1. Sinus tract formation
        2. Fibrosis
        3. Bridge scarring
        4. Hypertrophic Scar or Keloid
        5. Contractures
        6. Comedones
    2. Distribution
      1. Axilla (more common in women)
      2. Anogenital area (more common in men)
      3. Breasts
      4. Extension onto back and buttocks
  6. Differential Diagnosis
    1. Early
      1. Furuncle or Carbuncle
      2. Lymphadenitis
      3. Ruptured Trichilemmal Cyst
      4. Cat Scratch Disease
      5. Tularemia
    2. Late
      1. Lymphogranuloma venereum
      2. Donovanosis
      3. Tuberculosis
      4. Scrofuloderma
      5. Actinomycosis
      6. Ulcerative Colitis fistulae
      7. Regional Enteritis fistulae
  7. Associated Conditions
    1. Acanthosis Nigricans
    2. Crohn's Disease
    3. Down Syndrome
    4. Thyroiditis
    5. Hyperandrogenism
    6. Sjogren's Syndrome
  8. Management: Mild (Single Nodules with minimal pain)
    1. Avoid exposure to heat and humidity
    2. Avoid shaving if it causes irritation
    3. Avoid synthetic tight fitting clothes
    4. Use antibacterial soaps or hibiclens
    5. Weight loss
    6. Apply warm compresses to affected area
  9. Management: Moderate (Recurrent Nodules, pain, abscesses)
    1. Antibiotics for 2 months or more
      1. Axillary involvement
        1. Dicloxacillin
        2. Erythromycin
        3. Tetracycline
        4. Clindamycin Topically (Cleocin-T)
      2. Anogenital involvement
        1. Augmentin or other broad spectrum antibiotic
    2. Other options
      1. Oral Contraceptives (high Estrogen, low androgen)
        1. See Androgenic Activity
      2. Accutane 0.5 to 1 mg/kg PO daily
        1. Used before surgery
      3. Corticosteroids (variable efficacy)
        1. Prednisone 70 mg tapered over 14 days
        2. Intralesional triamcinolone
      4. Cryotherapy
  10. Management: Late (abscesses, sinuses, scarring)
    1. Referral to Dermatology
    2. Extensive surgical excision of lesions
  11. Complications
    1. Rectal or urethral fistulas
    2. Secondary infection
    3. Lymphedema
    4. Squamous Cell Carcinoma
  12. References
    1. Jansen (1998) Int J Dermatol 37:96
    2. Shah (2005) Am Fam Physician 72(8):1547

Hidradenitis (C0085160)

Definition (MSH)The inflammation of a sweat gland (usually of the apocrine type). The condition can be idiopathic or occur as a result of or in association with another underlying condition. Neutrophilic eccrine hidradenitis is a relatively rare variant that has been reported in patients undergoing chemotherapy, usually for non-Hodgkin lymphomas or leukemic conditions.
ConceptsDisease or Syndrome (T047)
ICD9705.83
MSHD016575
EnglishHidradenitides, Hidradenitis, Hidrosadenitides, Hidrosadenitis, Hydradenitides, Hydradenitis
Spanishgolondrino, hidradenitis, hidrosadenitis
Parent ConceptsOther specified sweat gland disorders (C0157735), Sweat Gland Diseases (C0038986), Dermatitis (C0011603), Duplicate concept (C1274013)
SourcesCOSTAR, ICD9CM, MSH, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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