Surgery for Hidradenitis Suppurativa Workup

  • Author: Naveen Pokala, MBBS, MS, FRCS; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: Nov 18, 2011
 

Laboratory Studies

  • Blood tests
    • A complete blood cell count identifies the underlying anemia associated with the chronic disease.
    • Blood sugar tests identify associated diabetes.
    • Cell-mediated and immune response studies and T- and B-cell assays usually return normal findings.
    • Routine endocrine assays identify the hormonal imbalances.
    • Routine biochemistry for preoperative workup is essential.
  • Microbiology
    • In the acute stages, the isolated organisms include the coagulase negative staphylococci, E coli, Streptococcus milleri, and the anaerobic Bacteroides species. Proteus species have been isolated from patients with chronic conditions.
    • Staphylococci have been shown to be the transient bacteria in the acute initial stages, whereas S milleri is the predominant organism in the chronic stages.
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Imaging Studies

  • CT scans can be useful before planning surgery because they help to accurately map the extent of disease.
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Histologic Findings

Early lesions show keratinous obstruction of the distal apocrine ducts, with dilatation and rupture of the adjacent tubules. Neutrophilic infiltrate is usually found within the tubule initially; after rupture, infiltrate is found in the surrounding tissue.

Chronic disease shows lymphocytic infiltration, granulation tissue, fibrous tissue, sinus tract formation, pseudoepitheliomatous hyperplasia, and obliteration of the glandular elements as the disease progresses.

While the earlier lesions are diagnostic of hidradenitis suppurativa, the later features can also be produced by severe cystic acne and by diseases that cause chronic sinus tract formation.

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Staging

The disease can be divided into the following 3 clinical stages:

  • Stage 1: Single or multiple abscesses form, without sinus tracts and cicatrization.
  • Stage 2: Recurrent abscesses form, with tract formation and cicatrization. There may be single or multiple widely separated lesions.
  • Stage 3: Diffuse or near-diffuse involvement or multiple interconnected tracts and abscesses are observed across the entire area.
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Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

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

Disclosure: Nothing to disclose.

Coauthor(s)

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

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: Medscape Salary Employment

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

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

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

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Table. The Pathogenesis of Hidradenitis Suppurativa
Keratin comedones



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Occlusion of the apocrine ducts



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Superimposed inflammation and infection



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Abscess formation



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Chronic infection and spread



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Induration and sinus and fistula formation



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