Hidradenitis Suppurativa in Emergency Medicine Follow-up

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

Further Inpatient Care

  • In severe cases, radical excision of the pathologic tissue with split-thickness skin grafts may be indicated.
  • Radiation and laser treatments may be considered as well. However, the reason to admit a patient from the emergency department with hidradenitis suppurativa would be due to toxicity or sepsis, so the main treatment would be supportive antibiotics, such as intravenous clindamycin, vancomycin, and piperacillin and tazobactam sodium (Zosyn).
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Deterrence/Prevention

  • Minimize heat exposure and sweating.[3]
  • Lose weight if overweight.[3]
  • Avoid constrictive clothing and frictional trauma.[3]
  • Avoid underarm antiperspirants and deodorants (this has not been proven to make a difference). Do not shave over the affected area.
  • Zinc gluconate supplements (zinc salts) taken daily may help reduce inflammation and prevent new outbreaks, as an alternative medicine theory.
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Complications

  • Lymphedema due to lymphatic injury from inflammation and scarring
  • Contracture formation at the sites of lesions
  • Squamous cell carcinoma (may develop in indolent sinus tracts)
  • Disseminated infection (rare)
  • Restricted limb mobility from scarring
  • Urethral/rectal fistula
  • Anemia secondary to chronic infection
  • Arthritis secondary to inflammatory injury
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Prognosis

  • Individual lesions usually heal slowly in 10-30 days with or without drainage.
  • Recurrences are common.
  • Spontaneous complete resolution occurs in rare cases.
  • Relentlessly progressive scarring and sinus tracts may occur.
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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].

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  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].

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  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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  23. Watson JD. Hidradenitis suppurativa--a clinical review. Br J Plast Surg. Oct 1985;38(4):567-9. [Medline].

  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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