Hidradenitis Suppurativa in Emergency Medicine Clinical Presentation

  • Author: Diana Fite, MD, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: May 3, 2012
 

History

The most common presentation of hidradenitis suppurativa is that of painful, tender, firm, nodular lesions under the arms.

  • The nodules may open and drain pus spontaneously. Nodules will heal slowly, with or without drainage, over 10-30 days.
  • In typical cases, nodules recur at least several times yearly.
  • In severe cases, the patient may suffer a constant succession of new lesions forming as soon as old lesions heal.
  • Excessive heat, perspiration, tight clothing,[4] and obesity[4] seem to aggravate the condition. Studies also show that cigarette smoking is a precipitator of the condition.
  • Remissions may last months or years.
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Physical

  • The patient may present in considerable pain, with multiple red, hard, raised nodules in areas where apocrine glands are concentrated.
  • Affected areas may include the axillae, periareolar, intermammary zones, pubic area, infraumbilical midline, gluteal folds, genitofemoral areas (top of the thighs in genital area), and the perianal region.
  • As suppuration progresses, surrounding cellulitis may be present. Chronic recurrences result in palpable thick sinus tracts under the skin, which may turn into draining fistulas.
  • The patient may present with a chronic condition in which the multiple nodules have coalesced and are surrounded by a fibrous reaction. This results in scarred and unsightly appearance of the area.
  • Hidradenitis suppurativa may resemble recurrent bacterial folliculitis and furunculosis.
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Causes

  • A genetic predisposition to hidradenitis suppurativa likely exists, with one study noting that 38% of patients had a relative with hidradenitis.[5]
  • Excessive perspiration, often observed in athletes and the obese, may contribute to clogging of the apocrine glands.
  • Disease activity may be related to stress and to cigarette smoking.
  • Hidradenitis may be observed as a primary condition without any obvious cause, but it may be observed in association with the following conditions:
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Contributor Information and Disclosures
Author

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.

Specialty Editor Board

Robert M McNamara, MD, FAAEM  Chair and Professor, Department of Emergency Medicine, Temple University School of Medicine

Robert M McNamara, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Pennsylvania Medical Society, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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

Mark W Fourre, MD  Program Director, Department of Emergency Medicine, Maine Medical Center; Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

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  2. Jemec GB. The symptomatology of hidradenitis suppurativa in women. Br J Dermatol. Sep 1988;119(3):345-50. [Medline].

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  5. von der Werth JM, Williams HC. The natural history of hidradenitis suppurativa. J Eur Acad Dermatol Venereol. Sep 2000;14(5):389-92. [Medline].

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

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

  8. Chaikin DC, Volz LR, Broderick G. An unusual presentation of hidradenitis suppurativa: case report and review of the literature. Urology. Oct 1994;44(4):606-8. [Medline].

  9. Deroo H, Aelbrecht M, t'Kindt J, Vermander F, De Bersaques J. Hidradenitis suppurativa. Dermatologica. 1990;180(3):193-4. [Medline].

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  16. Leitch DN, Holland CD, Langtry JA. Hidradenitis suppurativa and monoarthritis of the hip [letter]. Clin Exp Dermatol. Jul 1997;22(4):206-7. [Medline].

  17. Paletta C, Jurkiewicz MJ. Hidradenitis suppurativa. Clin Plast Surg. Apr 1987;14(2):383-90. [Medline].

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

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  24. Williams ST, Busby RC, DeMuth RJ, Nelson H. Perineal hidradenitis suppurativa: presentation of two unusual complications and a review. Ann Plast Surg. May 1991;26(5):456-62. [Medline].

 
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