Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Hidradenitis Suppurativa

  • Author: Marina Jovanovic, MD, PhD; Chief Editor: William D James, MD  more...
 
Updated: May 19, 2016
 

Practice Essentials

Hidradenitis suppurativa is a disorder of the terminal follicular epithelium in the apocrine gland–bearing skin. This condition is a chronic disabling disorder that relentlessly progresses, frequently causing keloids, contractures, and immobility. See the image below.

Close-up view of axillary hidradenitis suppurativa Close-up view of axillary hidradenitis suppurativa in a patient with pyoderma gangrenosum.

Signs and symptoms

Hidradenitis suppurativa usually occurs in otherwise healthy adolescents and adults. It rarely may begin before puberty. Hidradenitis suppurativa is characterized by comedolike follicular occlusion, chronic relapsing inflammation, mucopurulent discharge, and progressive scarring.

The onset of hidradenitis suppurativa is insidious, with the earliest sign being erythema. Later, the lesions become painful. Arthropathy associated with hidradenitis suppurativa may present with variable clinical features, ranging from asymmetric pauciarticular arthritis to a symmetric polyarthritis and/or polyarthralgia syndrome, as well as spondyloarthropathy. Moreover, epidemiological data also suggest an association of hidradenitis suppurativa with other diseases, including metabolic syndrome. Therefore, it is important to approach hidradenitis suppurativa as a systemic disease with an interprofessional team.[1, 2]

See Clinical Presentation for more detail.

Diagnosis

The diagnosis is primarily clinical, no pathognomonic test exists, and biopsy is rarely required, especially in well-developed lesions.[3] The consensus approach indicates that three key elements are required to diagnose hidradenitis suppurativa: typical lesions, characteristic distribution, and recurrence. Arbitrarily, two recurrences over a period of 6 months have been used as a qualifier for a diagnosis.[3] All three criteria must be present for the definitive diagnosis.[1]

Primary positive diagnostic criteria are as follows:

  • History: Recurrent painful or suppurating lesions more than twice in 6 months
  • Signs: Involvement of axilla, genitofemoral area, perineum, gluteal area and inframammary area of women; presence of nodules (inflamed or noninflamed), sinus tracts (inflamed or noninflamed), abscesses, and scarring (atrophic, meshlike, red, hypertrophic or linear)

Suspicion of the diagnosis can be strengthened by other factors that are not, however, pathognomonic.[1, 3]

Secondary positive diagnostic criteria are as follows:

  • History: Family history of hidradenitis suppurativa
  •  Microbiology: A negative swab or the presence of normal skin microbiota (may be indicative of hidradenitis suppurativa)

Typical lesions, called primary lesions, include the following:

  • Painful and/or tender erythematous papules smaller than 1 cm in diameter
  • Painful and/or tender erythematous nodules larger than 1 cm in diameter
  • Painful or tender abscesses and inflamed discharging papules or nodules
  • Dermal contractures and ropelike elevation of the skin
  • Double-ended comedones

The axillae and the groin are the 2 areas most frequently affected. These regions are defined by anatomic borders and are called designated sites. Hidradenitis suppurativa is diagnosed if the patient has 1 of the following:

  • Active disease with 1 or more primary lesions in a designated site, plus a history of 3 or more discharging or painful lumps (not specified) in designated sites since age 10 years
  • Inactive disease with a history of 5 or more discharging or painful lumps (unspecified) in designated sites since age 10 years, in the absence of current primary lesions [4]

Other authors have based the diagnosis on a series of questions, as follows[5] :

  • Is there more than a single inflamed lesion?
  • Is the course chronic, with new and recurrent lesions?
  • Are the lesions bilateral?
  • Are the lesions located primarily in the milk line?

Staging

The Hurley clinical staging of hidradenitis suppurativa from 1989 is still relevant today; it has diagnostic value but is not suitable for monitoring the efficacy of interventions in clinical trials.[1] This staging is as follows:

  • First stage: Solitary/multiple, isolated abscess formation without scarring or sinus tracts
  • Second stage: Recurrent abscesses, single/multiple widely separated lesions, with sinus tract formation and cicatrization
  • Third stage: Diffuse/broad involvement or multiple interconnected sinus tracts/abscesses across the entire area

Dynamic staging Sartorius Score systems have been used for assessing differences in treatment effects.[6] Uniform outcome variables should take into account the known characteristics of hidradenitis suppurativa, including the following[6] :

  • Anatomic region involved (axilla, groin, genital, gluteal, or other inflammatory region left and/or right): 3 points per region involved
  • Number and scores of lesions (abscesses, nodules, fistulas, scars): 2 points for each nodule, 4 points for each fistula, 1 point for each scar, 1 point each for "other"
  • Longest distance between 2 relevant lesions (ie, nodules and fistulas, in each region, or size if only 1 lesion): Less than 5 cm, 2 points; less than 10 cm, 4 points; more than 10 cm, 8 points
  • Lesions clearly separated by normal skin in each region: If yes, 0 points; if no, 6 points

A recently developed six-stage physician global assessment (PGA) is defined as follows:

  • Clear: No inflammatory or noninflammatory nodules
  • Minimal: Only the presence of noninflammatory nodules
  • Mild: Fewer than five inflammatory nodules or one abscess or draining fistula and no inflammatory nodules
  • Moderate: Fewer than five inflammatory nodules or one abscess or draining fistula and one or more inflammatory nodules or 2-5 abscesses or draining fistulas and fewer than 10 inflammatory nodules
  • Severe: Two to five abscesses or draining fistulas and 10 or more inflammatory nodules
  • Very severe: More than five abscesses or draining fistulas

However, a Hurley severity grade‒relevant conservative and surgical treatment for hidradenitis suppurativa is recommended.[1, 7] In order to assess any treatment effectiveness, it is very important to standardize relevant endpoints. Defined as at least a 50% reduction in total abscess and inflammatory nodule count with no increase in abscess count and no increase in draining fistula count relative to baseline at week 12, the hidradenitis suppurativa clinical response (HiSCR) is currently the most appropriate clinical endpoint to assess treatment and effectiveness for hidradenitis suppurativa treatment. It does not contradict hidradenitis suppurativa response measured by the modified Sartorius Score or PGA, but rather represents a more sensitive measure of change in disease activity, resulting in a more accurate representation of patient response and treatment evaluation. The HiSCR does not take into account the size or severity of individual lesions and does not measure how treatment response affects a patient’s level of pain or quality of life. However, the threshold of 50% reduction in total abscess and inflammatory nodule count is the defined level that is clinically appropriate and meaningful to the patient regarding improvement in quality of life and pain level.[8]

Laboratory testing

The following laboratory tests may be helpful in the evaluation of hidradenitis suppurativa:

  • Complete blood count with differential and platelet counts (occasionally elevated white blood count)
  • Erythrocyte sedimentation rate (may be elevated)
  • C-reactive protein assay
  • Urinalysis
  • Serum multiphasic analysis with determination of the serum iron level and serum protein electrophoresis (possibly low serum iron levels, serum protein abnormalities)

Other studies that may be helpful include the following:

  • Bacteriologic analysis (eg, bacteriologic sampling and cultivation)
  • Immunochemistry for various cytokeratins and 6 desmosomal cadherins (ie, desmogleins [Dsgs] 1-3, desmocollins [Dscs] 1-3)
  • Histologic examination

Imaging studies

Ultrasonography of the hair follicles and dermal thickness in hidradenitis suppurativa patients may reveal abnormalities in the deep part of the follicle.

See Workup for more detail.

Management

Medical management is recommended in early stages, whereas surgery should be performed after the formation of abscesses, fistulas, scars, and sinus tracts.[5]

Systemic treatment does not restore the skin’s original architecture; therefore, once the inflammation has been treated, epithelialized cysts and sinus tracts remain in the affected skin.[9]

Conservative treatment may include the following:

  • Local hygiene
  • Weight reduction in patients who are obese
  • Use of ordinary soaps and antiseptic and antiperspirant agents (eg, 6.25% aluminum chloride hexahydrate in absolute ethanol)
  • Application of warm compresses with sodium chloride solution or Burow solution
  • Wearing of loose-fitting clothing
  • Laser hair removal
  • Discontinuation of cigarette smoking
  • Medical anti-inflammatory or antiandrogen therapy (eg, oral or topical antibiotics, intralesional triamcinolone, spironolactone, finasteride)
  • Biological therapy

The following medications are used in the management of hidradenitis suppurativa:

  • Antibiotics (eg, tetracycline, doxycycline, minocycline, trimethoprim-sulfamethoxazole, clindamycin, erythromycin, dapsone)
  • Retinoids (eg, isotretinoin)
  • Corticosteroids (eg, triamcinolone, prednisolone, prednisone)
  • Antiandrogens (eg, cyproterone acetate, spironolactone)
  • Immunosuppressants (eg, adalimumab, infliximab, other biologic agents)
  • Estrogen derivatives (eg, ethinyl estradiol)
  • 5-Alpha-reductase inhibitors (eg, finasteride)

Surgery

Surgery is most valuable in the chronic and recurrent stages of hidradenitis suppurativa.[5, 7] Wide surgical excision, with margins well beyond the clinical borders of activity, remains the most definitive surgical therapy.[5, 8, 9] However, although recurrence rates may be lower with aggressive surgery, recurrences often continue.[10, 11] After radical excision, the disease has been reported to recur in 33% of patients,[11] and it may be as high as 50% in the submammary region.[12]

More limited surgical intervention may include the following[13, 14, 15, 16] :

  • Drainage
  • Nd:YAG laser treatment of lesions
  • Exteriorization
  • Curettage
  • Electrocoagulation of the sinus tracts
  • Deroofing and skin-tissue-saving excision with electrosurgical peeling
  • Simple excision of the troublesome areas with direct closure
  • Reconstruction with skin grafting and negative-pressure wound healing therapy
  • Placement of local cutaneous flaps, musculocutaneous flaps, pedicled and free flaps, or skin grafts
  • Secondary-intention healing

Radiotherapy

Nonablative radiofrequency therapy can be used for patients with Harley stage I and II disease.[17]

See Treatment and Medication for more detail.

Next

Background

Hidradenitis suppurativa (HS) is a disorder of the terminal follicular epithelium in the apocrine gland–bearing skin. Hidradenitis suppurativa is characterized by comedolike follicular occlusion, chronic relapsing inflammation, mucopurulent discharge, and progressive scarring.

Previous
Next

Pathophysiology

Hidradenitis suppurativa (HS) has traditionally been considered a disorder of the apocrine glands. Hidradenitis suppurativa was first described as a distinct entity in 1839, when Velpeau reported a patient with superficial abscess formation in the axillary, mammary, and perianal regions.[18] In 1854, Verneuil associated the suppurative process with the sweat glands, and the condition was given its current name. For many years, the condition was described as Verneuil disease, but it subsequently became known as hidradenitis suppurativa. Not having performed any histopathologic studies himself, Verneuil conceded that his conclusion was based purely on the characteristic distribution of the condition.[19]

In 1922, Schiefferdecker classified the sweat glands as eccrine and apocrine, and he subsequently localized hidradenitis suppurativa to the apocrine glands.[20] In 1939, Brunsting provided a detailed description of the histologic features of hidradenitis suppurativa. He observed the primary cellular reaction in the lumen of the apocrine glands and in the neighboring periglandular connective tissue. Detailing the clinical features of the disease, Brunsting highlighted its frequent association with acne. He noted that hidradenitis suppurativa, dissecting cellulitis of the scalp and the neck, and acne conglobata commonly occur in the same patient. He thought that the central pathogenetic event in all 3 conditions was a tendency for follicular hyperkeratinization with secondary bacterial infection.[21]

In 1956, Pillsbury et al combined acne conglobata, hidradenitis suppurativa, and dissecting cellulitis under the term follicular occlusion triad.[22] The only flaw in their concept was their focus on apocrine sweat gland involvement. In 1975, Plewig and Kligman added pilonidal sinus as another component to the ensemble, and they introduced the term acne tetrad.[23] Plewig and Kligman pointed out that hidradenitis suppurativa is a misnomer because of the lack of apocrine gland involvement, but they did not present a detailed explanation. In 1989, Plewig and Steger suggested the term acne inversa as an inclusive and accurate name for what was previously called the follicular occlusion triad, or follicular occlusion tetrad.[24] Eventually, hidradenitis suppurativa was accepted as an acneiform disorder that begins with follicular occlusion rather than an infection of the sweat glands.[25, 26]

Hidradenitis suppurativa is actually a defect of the follicular epithelium; therefore, there is a movement towards calling the disease acne inversa instead of hidradenitis suppurativa. The term acne inversa links the pathogenesis to acne and reflects the fact that it is an expression of follicular occlusion in localizations inverse to acne vulgaris.[27] However, hidradenitis suppurativa differs from acne in that no increase in sebaceous secretions is seen in hidradenitis suppurativa.

Previous
Next

Epidemiology

United States

In the United States, the prevalence of hidradenitis suppurativa appears to be 1-2% in the general population.

International

The prevalence of hidradenitis suppurativa appears to be 1% of the general population[28, 10] ; it was 4% in a group of young adults who were treated at a clinic for sexually transmitted diseases.[10] A 2008 study showed that the prevalence among persons aged 55 years and older was significantly lower than in younger age groups (0.5% vs 1.4%).[29] . Studies that provide prevalence or incidence estimations have been performed under different settings (hospital vs population-based) and in different periods.[28]

Race

Most authors report no specific racial predilection. One report suggests an increased incidence is observed in blacks, possibly because blacks have a greater density of apocrine glands than whites.[12]

Sex

Although hidradenitis suppurativa is widely considered to occur more frequently in females than in males, with a ratio as high as 2-5:1,[4, 30] reports on sex prevalence are controversial.[4, 31, 32] . In fact, females were more likely to have a family history of hidradenitis suppurativa, and men had a tendency for more severe disease and associated severe acne.[32]

Active genitofemoral lesions occur significantly more often in females, whereas perianal involvement tends to be more common in males. No sex difference is seen in the axillary lesions. Comedones have been suggested as precursor lesions for hidradenitis suppurativa, and they appear to be equally distributed in both sexes and sites.[33]

Age

The onset of hidradenitis suppurativa ranges from 11-50 years, with an average patient age of 23 years.[4] In less than 2% of patients, the disease appears before age 11 years.[34] In extremely rare cases, hidradenitis suppurativa occurs before puberty, but it has been suggested that a prepubertal onset is not uncommon in severely affected patients.[35, 36] or after menopause.[37]

Previous
Next

Mortality/Morbidity

Hidradenitis suppurativa is a chronic disabling disorder that relentlessly progresses, frequently causing keloids, contractures, and immobility.

The disorder has significant socioeconomic effects as well. Jemec et al documented, in the Danish population, an average of 2.7 lost work days per year due to hidradenitis suppurativa (overall workdays lost was 7.5).[30] The general self-reported level of health, which is well correlated with more objective parameters of morbidity, was also significantly worse among hidradenitis suppurativa patients than healthy control subjects.[30] The mean Dermatology Life Quality Index (DLQI) score for hidradenitis suppurativa is higher than for previously studied skin diseases, indicating significant morbidity for those affected.[4]

Previous
Next

Prognosis

In general, hidradenitis suppurativa is a chronic disease, as underscored by the finding that 90% of patients in one large series still had active disease in the last year despite an average disease duration of nearly 19 years.[4]

The impression of a relentlessly progressive disorder may be explained by the finding that almost two thirds of patients acknowledged the existence of persistently painful boils that failed to heal. Possibly, new boils develop at an unchanged rate throughout the course of the disease, but some fail to subside in the usual manner and become chronic.[4]

With rare exceptions, surgical intervention is sufficient to stop the disease.[38] Shame, frustration, and despair may cause patients to delay radical surgical procedures.

No single treatment has shown overwhelmingly positive outcomes.[39]

Spontaneous resolution is rare.[7]

Specific factors appear to influence the prognosis. Larger excisions may offer a better outcome. Better results can be obtained by leaving wounds to secondary healing. Perianal surgery, axillary surgery, and older patient age are associated with lower recurrence rates, irrespective of the preoperative duration.[33]

The recurrence rate in patients treated with radical surgery varies considerably depending on the site affected; the highest rate is 50% in the submammary region.[12] An overall recurrence rate of 2.5% have been estimated after wide surgical excision, with a median postoperative follow-up of 36 months.[7]

The postoperative relapse risk is higher in women after surgery under general anaesthesia in severe hidradenitis suppurativa.[36]

If untreated, the disease causes significant morbidity, particularly in women and patients with moderate and severe disease who are more likely to experience a significant diagnostic delay (>2 y).[40]

Previous
Next

Patient Education

Patients should be educated about the initial treatments, which include the following[15] (see Medical Care):

  • Practicing proper hygiene
  • Using soaps and antiseptic and antiperspirant agents
  • Using warm compresses
  • Wearing loose-fitting clothing
  • Smoking cessation

Patients who are obese should be educated about weight loss (see Diet). Additionally, patients should be educated about activities that may provide some relief of their condition[4] (see Activity). These activities include swimming, bathing, and avoiding smoking.

For patient education resources, see the Skin Conditions and Beauty Center. Also see the patient education article Boils.

Previous
 
 
Contributor Information and Disclosures
Author

Marina Jovanovic, MD, PhD Chief of Dermatology Ward and Contact Dermatitis Investigative Unit, Clinic of Dermatoveneroleogic Diseases, Clinical Center, Novi Sad, Serbia; Professor in Dermatology, Medical Faculty, University of Novi Sad, Vojvodina, Serbia

Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

George Kihiczak, MD Clinical Associate Professor, Department of Dermatology, New Jersey Medical School and University Hospital

George Kihiczak, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Medical Society of New Jersey

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Andrea Leigh Zaenglein, MD Professor of Dermatology and Pediatrics, Department of Dermatology, Hershey Medical Center, Pennsylvania State University College of Medicine

Andrea Leigh Zaenglein, MD is a member of the following medical societies: American Academy of Dermatology, Society for Pediatric Dermatology

Disclosure: Received consulting fee from Galderma for consulting; Received consulting fee from Valeant for consulting; Received consulting fee from Promius for consulting; Received consulting fee from Anacor for consulting; Received grant/research funds from Stiefel for investigator; Received grant/research funds from Astellas for investigator; Received grant/research funds from Ranbaxy for other; Received consulting fee from Ranbaxy for consulting.

Acknowledgements

Diana Fite, MD, FACEP Clinical Assistant Professor, Department of Emergency Medicine, University of Texas Medical School at Houston, Hermann Hospital

Diana Fite, MD, FACEP is a member of the following medical societies: American Association of Women Emergency Physicians, American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Texas Medical Association

Disclosure: Nothing to disclose.

John Geibel, MD, DSc, MA Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital

John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract

Disclosure: AMGEN Royalty Consulting; Ardelyx Ownership interest Board membership

Ravi Pokala Kiran, MBBS, MS, FRCS (Eng), FRCS (Glas) Staff Physician, Department of General Surgery, St Mary's Hospital

Disclosure: Nothing to disclose.

David L Morris, MD, PhD, FRACS Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia

David L Morris, MD, PhD, FRACS is a member of the following medical societies: British Society of Gastroenterology

Disclosure: RFA Medical None Director; MRC Biotec None Director

Naveen Pokala, MBBS, MS, FRCS Staff Physician, Department of Surgery, Bronx Lebanon Hospital

Disclosure: Nothing to disclose.

References
  1. [Guideline] Zouboulis CC, Desai N, Emtestam L, Hunger RE, Ioannides D, Juhász I, et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol. 2015 Apr. 29 (4):619-44. [Medline].

  2. Wang SC, Wang SC, Alavi A, Alhusayen R, Bashash M, Sibbald RG. Hidradenitis Suppurativa: A Frequently Missed Diagnosis, Part 2: Treatment Options. Adv Skin Wound Care. 2015 Aug. 28 (8):372-80; quiz 381-2. [Medline].

  3. van der Zee HH, Jemec GB. New insights into the diagnosis of hidradenitis suppurativa: Clinical presentations and phenotypes. J Am Acad Dermatol. 2015 Nov. 73 (5 Suppl 1):S23-6. [Medline].

  4. von der Werth JM, Jemec GB. Morbidity in patients with hidradenitis suppurativa. Br J Dermatol. 2001 Apr. 144(4):809-13. [Medline].

  5. Alikhan A, Lynch PJ, Eisen DB. Hidradenitis suppurativa: a comprehensive review. J Am Acad Dermatol. 2009 Apr. 60(4):539-61; quiz 562-3. [Medline].

  6. Sartorius K, Lapins J, Emtestam L, Jemec GB. Suggestions form uniform outcome variables when reporting treatment effects in hidradenitis suppurativa. Br J Dermatol. 2003. 149:211-3.

  7. Rompel R, Petres J. Long-term results of wide surgical excision in 106 patients with hidradenitis suppurativa. Dermatol Surg. 2000 Jul. 26(7):638-43. [Medline].

  8. Kimball AB, Jemec GB, Yang M, Kageleiry A, Signorovitch JE, Okun MM, et al. Assessing the validity, responsiveness and meaningfulness of the Hidradenitis Suppurativa Clinical Response (HiSCR) as the clinical endpoint for hidradenitis suppurativa treatment. Br J Dermatol. 2014 Dec. 171 (6):1434-42. [Medline].

  9. Blok JL, Spoo JR, Leeman FW, Jonkman MF, Horváth B. Skin-Tissue-sparing Excision with Electrosurgical Peeling (STEEP): a surgical treatment option for severe hidradenitis suppurativa Hurley stage II/III. J Eur Acad Dermatol Venereol. 2015 Feb. 29 (2):379-82. [Medline].

  10. Jemec GB. What's new in hidradenitis suppurativa?. J Eur Acad Dermatol Venereol. 2000 Sep. 14(5):340-1. [Medline].

  11. Bohn J, Svensson H. Surgical treatment of hidradenitis suppurativa. Scand J Plast Reconstr Surg Hand Surg. 2001 Sep. 35(3):305-9. [Medline].

  12. Parks RW, Parks TG. Pathogenesis, clinical features and management of hidradenitis suppurativa. Ann R Coll Surg Engl. 1997 Mar. 79(2):83-9. [Medline]. [Full Text].

  13. Slade DE, Powell BW, Mortimer PS. Hidradenitis suppurativa: pathogenesis and management. Br J Plast Surg. 2003 Jul. 56(5):451-61. [Medline].

  14. Tanaka A, Hatoko M, Tada H, Kuwahara M, Mashiba K, Yurugi S. Experience with surgical treatment of hidradenitis suppurativa. Ann Plast Surg. 2001 Dec. 47(6):636-42. [Medline].

  15. Golcman R, Golcman B, Tamura BM, Nogueira MA, Zoo CM, Germano JA. Subcutaneous fistulectomy in bridging hidradenitis suppurativa. Dermatol Surg. 1999 Oct. 25(10):795-8. [Medline].

  16. Tierney E, Mahmoud BH, Hexsel C, Ozog D, Hamzavi I. Randomized control trial for the treatment of hidradenitis suppurativa with a neodymium-doped yttrium aluminium garnet laser. Dermatol Surg. 2009 Aug. 35(8):1188-98. [Medline].

  17. Iwasaki J, Marra DE, Fincher EF, Moy RL. Treatment of hidradenitis suppurativa with a nonablative radiofrequency device. Dermatol Surg. 2008 Jan. 34(1):114-7. [Medline].

  18. Velpeau A. Dictionnaire de Medicine, un Repertoire des Sciences Medicales sons le Rapport, Theorique et Pratique. 2nd ed Paris. 1839. 91.

  19. Verneuil A. Etudes sur les tumeurs de la peau et quelques maladies des glandes sudoripores. Arch Gen Med. 1854. 4:693-705.

  20. Schiefferdecker B. Die Hautdrusen des Menschen und der Saugetierre ihre Histologishe und rassenanatomische Bedeutung Sowie die Muscularis Sexualis. Stuttgart. 1922.

  21. Brunsting HA. Hidradenitis suppurativa: abscess of the apocrine sweat glands. Arch fur Dermatol und Syph (Berlin). 1939. 39:108-20.

  22. Pillsbury DM, Shelley WB, Kligman AM. Bacterial infections of the skin. Dermatology. Philadelphia: WB Saunders Co; 1956. 482-9.

  23. Plewig G, Kligman AM. Acne: Morphogenesis and Treatment. Berlin: Springer-Verlag; 1975.

  24. Plewig G, Steger M. Acne inversa (alias acne triad, acne tetrad, or hydradenitis suppurativa). Marks R, Plewig G, eds. Acne and Related Disorders. London: Martin Dunitz Ltd; 1989. 343-57.

  25. Yu CC, Cook MG. Hidradenitis suppurativa: a disease of follicular epithelium, rather than apocrine glands. Br J Dermatol. 1990 Jun. 122(6):763-9. [Medline].

  26. Attanoos RL, Appleton MA, Douglas-Jones AG. The pathogenesis of hidradenitis suppurativa: a closer look at apocrine and apoeccrine glands. Br J Dermatol. 1995 Aug. 133(2):254-8. [Medline].

  27. Sellheyer K, Krahl D. "Hidradenitis suppurativa" is acne inversa! An appeal to (finally) abandon a misnomer. Int J Dermatol. 2005 Jul. 44(7):535-40. [Medline].

  28. Gulliver W, Zouboulis CC, Prens E, Jemec GB, Tzellos T. Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa. Rev Endocr Metab Disord. 2016 Feb 1. 35(2 Pt 1):191-4. [Medline].

  29. Revuz JE, Canoui-Poitrine F, Wolkenstein P, et al. Prevalence and factors associated with hidradenitis suppurativa: results from two case-control studies. J Am Acad Dermatol. 2008 Oct. 59(4):596-601. [Medline].

  30. Jemec GB, Heidenheim M, Nielsen NH. Hidradenitis suppurativa--characteristics and consequences. Clin Exp Dermatol. 1996 Nov. 21(6):419-23. [Medline].

  31. Manolitsas T, Biankin S, Jaworski R, Wain G. Vulval squamous cell carcinoma arising in chronic hidradenitis suppurativa. Gynecol Oncol. 1999 Nov. 75(2):285-8. [Medline].

  32. Wang SC, Wang SC, Sibbald RG, Alhusayen R, Bashash M, Alavi A. Hidradenitis Suppurativa: A Frequently Missed Diagnosis, Part 1: A Review of Pathogenesis, Associations, and Clinical Features. Adv Skin Wound Care. 2015 Jul. 28 (7):325-32; quiz 333-4. [Medline].

  33. Jemec GB. Hidradenitis suppurativa. J Cutan Med Surg. 2003 Jan-Feb. 7(1):47-56. [Medline].

  34. Palmer RA, Keefe M. Early-onset hidradenitis suppurativa. Clin Exp Dermatol. 2001 Sep. 26(6):501-3. [Medline].

  35. Mengesha YM, Holcombe TC, Hansen RC. Prepubertal hidradenitis suppurativa: two case reports and review of the literature. Pediatr Dermatol. 1999 Jul-Aug. 16(4):292-6. [Medline].

  36. Blok JL, Boersma M, Terra JB, Spoo JR, Leeman FW, van den Heuvel ER, et al. Surgery under general anaesthesia in severe hidradenitis suppurativa: a study of 363 primary operations in 113 patients. J Eur Acad Dermatol Venereol. 2015 Aug. 29 (8):1590-7. [Medline].

  37. Barth JH, Layton AM, Cunliffe WJ. Endocrine factors in pre- and postmenopausal women with hidradenitis suppurativa. Br J Dermatol. 1996 Jun. 134(6):1057-9. [Medline].

  38. Mandal A, Watson J. Experience with different treatment modules in hidradenitis suppuritiva: a study of 106 cases. Surgeon. 2005 Feb. 3(1):23-6. [Medline].

  39. Hughes R, Kelly G, Sweeny C, Lally A, Kirby B. The medical and laser management of hidradenitis suppurativa. Am J Clin Dermatol. 2015 Apr. 16 (2):111-23. [Medline].

  40. Saunte DM, Boer J, Stratigos A, et al. Diagnostic delay in hidradenitis suppurativa is a global problem. Br J Dermatol. 2015 Dec. 173 (6):1546-9. [Medline].

  41. Roy MK, Appleton MA, Delicata RJ, Sharma AK, Williams GT, Carey PD. Probable association between hidradenitis suppurativa and Crohn's disease: significance of epithelioid granuloma. Br J Surg. 1997 Mar. 84(3):375-6. [Medline].

  42. Martínez F, Nos P, Benlloch S, Ponce J. Hidradenitis suppurativa and Crohn's disease: response to treatment with infliximab. Inflamm Bowel Dis. 2001 Nov. 7(4):323-6. [Medline].

  43. Church JM, Fazio VW, Lavery IC, Oakley JR, Milsom JW. The differential diagnosis and comorbidity of hidradenitis suppurativa and perianal Crohn's disease. Int J Colorectal Dis. 1993 Sep. 8(3):117-9. [Medline].

  44. Jansen T, Plewig G. What's new in acne inversa (alias hidradenitis suppurativa)?. J Eur Acad Dermatol Venereol. 2000 Sep. 14(5):342-3. [Medline].

  45. Gonzalez-Lopez A, Velasco E, Pozo T, Del Villar A. HIV-associated pityriasis rubra pilaris responsive to triple antiretroviral therapy. Br J Dermatol. 1999 May. 140(5):931-4. [Medline].

  46. Kleeman D, Trueb RM, Schmid-Grendelmeier P. [Reticular pigmented anomaly of the flexures. Dowling-Degos disease of the intertrigo type in association with acne inversa]. Hautarzt. 2001 Jul. 52(7):642-5. [Medline].

  47. Libow LF, Friar DA. Arthropathy associated with cystic acne, hidradenitis suppurativa, and perifolliculitis capitis abscedens et suffodiens: treatment with isotretinoin. Cutis. 1999 Aug. 64(2):87-90. [Medline].

  48. Thein M, Hogarth MB, Acland K. Seronegative arthritis associated with the follicular occlusion triad. Clin Exp Dermatol. 2004. 29:545-62.

  49. Bhosale P, Barron B, Lamki L. The "SAPHO" syndrome: a case report of a patient with unusual bone scan findings. Clin Nucl Med. 2001 Jul. 26(7):619-21. [Medline].

  50. Ah-Weng A, Langtry JA, Velangi S, Evans CD, Douglas WS. Pyoderma gangrenosum associated with hidradenitis suppurativa. Clin Exp Dermatol. 2005 Nov. 30(6):669-71. [Medline].

  51. Pavlovic M. Oboljenja apokrinih znojnih zlezda. Karadaglic D, ed. Dermatologija Beograd: Vojnoizdavacki Zavod. 2000. 754-61.

  52. Shelley WB, Cahn MM. The pathogenesis of hidradenitis suppurativa in man; experimental and histologic observations. AMA Arch Derm. 1955 Dec. 72(6):562-5. [Medline].

  53. Lapins J, Jarstrand C, Emtestam L. Coagulase-negative staphylococci are the most common bacteria found in cultures from the deep portions of hidradenitis suppurativa lesions, as obtained by carbon dioxide laser surgery. Br J Dermatol. 1999 Jan. 140(1):90-5. [Medline].

  54. Mowad CM, McGinley KJ, Foglia A, Leyden JJ. The role of extracellular polysaccharide substance produced by Staphylococcus epidermidis in miliaria. J Am Acad Dermatol. 1995 Nov. 33(5 Pt 1):729-33. [Medline].

  55. Kurzen H, Kurokawa I, Jemec GB, et al. What causes hidradenitis suppurativa?. Exp Dermatol. 2008 May. 17(5):455-6; discussion 457-72. [Medline].

  56. Fitzsimmons JS, Guilbert PR, Fitzsimmons EM. Evidence of genetic factors in hidradenitis suppurativa. Br J Dermatol. 1985 Jul. 113(1):1-8. [Medline].

  57. Pink AE, Simpson MA, Desai N, Trembath RC, Barker JN. Gamma-Secretase mutations in hidradenitis suppurativa: new insights into disease pathogenesis. J Invest Dermatol. 2013 Mar. 133(3):601-7. [Medline].

  58. Gao M, Wang PG, Cui Y, et al. Inversa acne (hidradenitis suppurativa): a case report and identification of the locus at chromosome 1p21.1-1q25.3. J Invest Dermatol. 2006 Jun. 126(6):1302-6. [Medline].

  59. Lapins J, Asman B, Gustafsson A, Bergstrom K, Emtestam L. Neutrophil-related host response in hidradenitis suppurativa: a pilot study in patients with inactive disease. Acta Derm Venereol. 2001 May. 81(2):96-9. [Medline].

  60. Giamarellos-Bourboulis EJ, Antonopoulou A, Petropoulou C, et al. Altered innate and adaptive immune responses in patients with hidradenitis suppurativa. Br J Dermatol. 2007 Jan. 156(1):51-6. [Medline].

  61. Hunger RE, Surovy AM, Hassan AS, Braathen LR, Yawalkar N. Toll-like receptor 2 is highly expressed in lesions of acne inversa and colocalizes with C-type lectin receptor. Br J Dermatol. 2008 Apr. 158(4):691-7. [Medline].

  62. Champion RH. Disorder of sweat glands. Rook A, Wilkinson DS, Ebling FJ, eds. Textbook of Dermatology. 6th ed. Oxford: Blackwell Science; 1998. 1985-2002.

  63. Edlich RF, Winters KL, Britt LD, Long WB 3rd, Gubler KD, Drake DB. Difficult wounds: an update. J Long Term Eff Med Implants. 2005. 15(3):289-302. [Medline].

  64. Wiseman MC. Hidradenitis suppurativa: a review. Dermatol Ther. 2004. 17(1):50-4. [Medline].

  65. Lewis F, Messenger AG, Wales JK. Hidradenitis suppurativa as a presenting feature of premature adrenarche. Br J Dermatol. 1993 Oct. 129(4):447-8. [Medline].

  66. Farrell AM, Randall VA, Vafaee T, Dawber RP. Finasteride as a therapy for hidradenitis suppurativa. Br J Dermatol. 1999 Dec. 141(6):1138-9. [Medline].

  67. Barth JH. Cutaneous Virilism, Apocrine Glands and Hidradenitis Suppurativa [thesis]. London: University of London; 1992.

  68. Jemec GB, Gniadecka M. Sebum excretion in hidradenitis suppurativa. Dermatology. 1997. 194(4):325-8. [Medline].

  69. Jansen I, Altmeyer P, Piewig G. Acne inversa (alias hidradenitis suppurativa). J Eur Acad Dermatol Venereol. 2001 Nov. 15(6):532-40. [Medline].

  70. Wasik F, Barancewicz-Losek M. Hryncewicz-Gwozdz A, Jelen M: Hidradenitis suppurativa complicated by hidradenocarcinoma. Dermatol Klin (Wroclaw). 2001. 3 (Suppl 1):64.

  71. Jansen T, Plewig G. Acne inversa. Int J Dermatol. 1998 Feb. 37(2):96-100. [Medline].

  72. Kurzen H, Jung EG, Hartschuh W, Moll I, Franke WW, Moll R. Forms of epithelial differentiation of draining sinus in acne inversa (hidradenitis suppurativa). Br J Dermatol. 1999 Aug. 141(2):231-9. [Medline].

  73. Kurokawa I, Nishijima S, Kusumoto K, Senzaki H, Shikata N, Tsubura A. Immunohistochemical study of cytokeratins in hidradenitis suppurativa (acne inversa). J Int Med Res. 2002 Mar-Apr. 30(2):131-6. [Medline].

  74. Kurokawa I, Nishijima S, Suzuki K, et al. Cytokeratin expression in pilonidal sinus. Br J Dermatol. 2002 Mar. 146(3):409-13. [Medline].

  75. Kurokawa I, Nishimura K, Yamanaka K, Mizutani H, Tsubura A, Revuz J. Cytokeratin expression in squamous cell carcinoma arising from hidradenitis suppurativa (acne inversa). J Cutan Pathol. 2007 Sep. 34(9):675-8. [Medline].

  76. Jemec GB, Gniadecka M. Ultrasound examination of hair follicles in hidradenitis suppurativa. Arch Dermatol. 1997 Aug. 133(8):967-70. [Medline].

  77. Jansen T, Romiti R, Plewig G, Altmeyer P. Disfiguring draining sinus tracts in a female acne patient. Pediatr Dermatol. 2000 Mar-Apr. 17(2):123-5. [Medline].

  78. Gniadecki R, Jemec GB. Lipid raft-enriched stem cell-like keratinocytes in the epidermis, hair follicles and sinus tracts in hidradenitis suppurativa. Exp Dermatol. 2004 Jun. 13(6):361-3. [Medline].

  79. Matusiak L, Bieniek A, Szepietowski JC. Soluble interleukin-2 receptor serum level is a useful marker of hidradenitis suppurativa clinical staging. Biomarkers. 2009 Sep. 14(6):432-7. [Medline].

  80. Aksakal AB, Adisen E. Hidradenitis suppurativa: importance of early treatment; efficient treatment with electrosurgery. Dermatol Surg. 2008 Feb. 34(2):228-31. [Medline].

  81. Boer J, van Gemert MJ. Long-term results of isotretinoin in the treatment of 68 patients with hidradenitis suppurativa. J Am Acad Dermatol. 1999 Jan. 40(1):73-6. [Medline].

  82. van Rappard DC, Mooij JE, Mekkes JR. Mild to moderate hidradenitis suppurativa treated with local excision and primary closure. J Eur Acad Dermatol Venereol. 2012 Jul. 26(7):898-902. [Medline].

  83. Yamashita Y, Hashimoto I, Matsuo S, Abe Y, Ishida S, Nakanishi H. Two-stage surgery for hidradenitis suppurativa: staged artificial dermis and skin grafting. Dermatol Surg. 2014 Feb. 40(2):110-5. [Medline].

  84. Jianbing T, Biao C, Qin L, Yanhong W. Topical negative pressure coupled with split-thickness skin grafting for the treatment of hidradenitis suppurativa: a case report. Int Wound J. 2013 Jul 9. [Medline].

  85. Busnardo FF, Coltro PS, Olivan MV, Busnardo AP, Ferreira MC. The thoracodorsal artery perforator flap in the treatment of axillary hidradenitis suppurativa: effect on preservation of arm abduction. Plast Reconstr Surg. 2011 Oct. 128(4):949-53. [Medline].

  86. Alharbi M, Perignon D, Assaf N, Qassemyar Q, Elsamad Y, Sinna R. Application of the inner arm perforator flap in the management of axillary hidradenitis suppurativa. Ann Chir Plast Esthet. 2014 Feb. 59(1):29-34. [Medline].

  87. Bodzin JH. Laser ablation of complex perianal fistulas preserves continence and is a rectum-sparing alternative in Crohn's disease patients. Am Surg. 1998 Jul. 64(7):627-31; discussion 632. [Medline].

  88. Lapins J, Sartorius K, Emtestam L. Scanner-assisted carbon dioxide laser surgery: a retrospective follow-up study of patients with hidradenitis suppurativa. J Am Acad Dermatol. 2002 Aug. 47(2):280-5. [Medline].

  89. Madan V, Hindle E, Hussain W, August PJ. Outcomes of treatment of nine cases of recalcitrant severe hidradenitis suppurativa with carbon dioxide laser. Br J Dermatol. 2008 Dec. 159(6):1309-14. [Medline].

  90. Hynes PJ, Earley MJ, Lawlor D. Split-thickness skin grafts and negative-pressure dressings in the treatment of axillary hidradenitis suppurativa. Br J Plast Surg. 2002 Sep. 55(6):507-9. [Medline].

  91. Rehman N, Kannan RY, Hassan S, Hart NB. Thoracodorsal artery perforator (TAP) type I V-Y advancement flap in axillary hidradenitis suppurativa. Br J Plast Surg. 2005 Jun. 58(4):441-4. [Medline].

  92. Rhode JM, Burke WM, Cederna PS, Haefner HK. Outcomes of surgical management of stage III vulvar hidradenitis suppurativa. J Reprod Med. 2008 Jun. 53(6):420-8. [Medline].

  93. Frohlich D, Baaske D, Glatzel M. [Radiotherapy of hidradenitis suppurativa--still valid today?]. Strahlenther Onkol. 2000 Jun. 176(6):286-9. [Medline].

  94. Russ E, Castillo M. Lumbosacral epidural abscess due to hidradenitis suppurativa. AJR Am J Roentgenol. 2002 Mar. 178(3):770-1. [Medline].

  95. Gupta S, Kumar B. Dorsal perforation of prepuce: a common end point of severe ulcerative genital diseases?. Sex Transm Infect. 2000 Jun. 76(3):210-2. [Medline].

  96. Lapins J, Ye W, Nyren O, Emtestam L. Incidence of cancer among patients with hidradenitis suppurativa. Arch Dermatol. 2001 Jun. 137(6):730-4. [Medline].

  97. Malaguarnera M, Pontillo T, Pistone G, Succi L. Squamous-cell cancer in Verneuil's disease (hidradenitis suppurativa). Lancet. 1996 Nov 23. 348(9039):1449. [Medline].

  98. Maclean GM, Coleman DJ. Three fatal cases of squamous cell carcinoma arising in chronic perineal hidradenitis suppurativa. Ann R Coll Surg Engl. 2007 Oct. 89(7):709-12. [Medline].

  99. Crain VA, Gulati S, Bhat S, Milner SM. Marjolin's ulcer in chronic hidradenitis suppurativa. Am Fam Physician. 2005 May 1. 71(9):1652, 1657. [Medline].

  100. Kimball AB, Sobell JM, Zouboulis CC, Gu Y, Williams DA, Sundaram M, et al. HiSCR (Hidradenitis Suppurativa Clinical Response): a novel clinical endpoint to evaluate therapeutic outcomes in patients with hidradenitis suppurativa from the placebo-controlled portion of a phase 2 adalimumab study. J Eur Acad Dermatol Venereol. 2015 Jul 22. 27(6):528-9. [Medline].

  101. Yildiz H, Senol L, Ercan E, Bilgili ME, Karabudak Abuaf O. A prospective randomized controlled trial assessing the efficacy of adjunctive hyperbaric oxygen therapy in the treatment of hidradenitis suppurativa. Int J Dermatol. 2016 Feb. 55 (2):232-7. [Medline].

  102. Jemec GB. Clinical practice. Hidradenitis suppurativa. N Engl J Med. 2012 Jan 12. 366(2):158-64. [Medline].

  103. Boer J, Nazary M. Long-term results of acitretin therapy for hidradenitis suppurativa. Is acne inversa also a misnomer?. Br J Dermatol. 2011 Jan. 164(1):170-5. [Medline].

  104. Jamshidi M, Obermeyer RJ, Govindaraj S, Garcia A, Ghani A. Acute pancreatitis secondary to isotretinoin-induced hyperlipidemia. J Okla State Med Assoc. 2002 Feb. 95(2):79-80. [Medline].

  105. Katsanos KH, Christodoulou DK, Tsianos EV. Axillary hidradenitis suppurativa successfully treated with infliximab in a Crohn's disease patient. Am J Gastroenterol. 2002 Aug. 97(8):2155-6. [Medline].

  106. Lebwohl B, Sapadin AN. Infliximab for the treatment of hidradenitis suppurativa. J Am Acad Dermatol. 2003 Nov. 49(5 Suppl):S275-6. [Medline].

  107. Rosi YL, Lowe L, Kang S. Treatment of hidradenitis suppurativa with infliximab in a patient with Crohn's disease. J Dermatolog Treat. 2005 Feb. 16(1):58-61. [Medline].

  108. Trent JT, Kerdel FA. Tumor necrosis factor alpha inhibitors for the treatment of dermatologic diseases. Dermatol Nurs. 2005 Apr. 17(2):97-107. [Medline].

  109. Sullivan TP, Welsh E, Kerdel FA, Burdick AE, Kirsner RS. Infliximab for hidradenitis suppurativa. Br J Dermatol. 2003 Nov. 149(5):1046-9. [Medline].

  110. Gupta AK, Skinner AR. A review of the use of infliximab to manage cutaneous dermatoses. J Cutan Med Surg. 2004 Mar-Apr. 8(2):77-89. [Medline].

  111. Grant A, Gonzalez T, Montgomery MO, Cardenas V, Kerdfel FA. Infliximab therapy for patients with moderate to severe hidradenitis suppurativa: A randomized, double blind, placebo-control crossover trial. J Am Acad Dermatol. 2010. 62:205-17.

  112. Mekkes JR, Bos JD. Long-term efficacy of a single course of infliximab in hidradenitis suppurativa. Br J Dermatol. 2008 Feb. 158(2):370-4. [Medline].

  113. Ingram JR, McPhee M. Management of hidradenitis suppurativa: a U.K. survey of current practice. Br J Dermatol. 2015 Oct. 173 (4):1070-2. [Medline].

  114. Ingram JR, Woo PN, Chua SL, Ormerod AD, Desai N, Kai AC, et al. Interventions for hidradenitis suppurativa: a Cochrane systematic review incorporating GRADE assessment of evidence quality. Br J Dermatol. 2016 Jan 23. 32(2):204-5. [Medline].

  115. Lee RA, Dommasch E, Treat J, et al. A prospective clinical trial of open-label etanercept for the treatment of hidradenitis suppurativa. J Am Acad Dermatol. 2009 Apr. 60(4):565-73. [Medline].

  116. Giamarellos-Bourboulis EJ, Pelekanou E, Antonopoulou A, et al. An open-label phase II study of the safety and efficacy of etanercept for the therapy of hidradenitis suppurativa. Br J Dermatol. 2008 Mar. 158(3):567-72. [Medline].

  117. Zangrilli A, Esposito M, Mio G, Mazzotta A, Chimenti S. Long-term efficacy of etanercept in hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2008 Nov. 22(10):1260-2. [Medline].

  118. Yamauchi PS, Mau N. Hidradenitis suppurativa managed with adalimumab. J Drugs Dermatol. 2009 Feb. 8(2):181-3. [Medline].

  119. Boer J, Jemec GB. Resorcinol peels as a possible self-treatment of painful nodules in hidradenitis suppurativa. Clin Exp Dermatol. 2010 Jan. 35(1):36-40. [Medline].

 
Previous
Next
 
Vulvar hidradenitis suppurativa.
Vulvar and inguinal indurations.
Sinus tract.
Draining sinus tract.
Axillary hidradenitis suppurativa in a patient with pyoderma gangrenosum.
Close-up view of axillary hidradenitis suppurativa in a patient with pyoderma gangrenosum.
Submammary hidradenitis suppurativa in a patient with pyoderma gangrenosum.
Double-ended-comedones. Hidradenitis suppurativa in a patient with pyoderma gangrenosum.
Inguinal hidradenitis suppurativa in a patient with pyoderma gangrenosum.
Close-up view of inguinal hidradenitis suppurativa in a patient with pyoderma gangrenosum.
Pyoderma gangrenosum in a patient with hidradenitis suppurativa.
Close-up view of pyoderma gangrenosum in a patient with hidradenitis suppurativa.
Coexisting hidradenitis suppurativa and pyoderma gangrenosum.
Coexisting hidradenitis suppurativa and pyoderma gangrenosum.
Hidradenitis suppurativa in a patient with pyoderma gangrenosum.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.