Hidradenitis Suppurativa in Emergency Medicine 

  • Author: Diana Fite, MD, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: May 5, 2010
 

Background

Hidradenitis suppurativa is an annoying chronic condition characterized by swollen, painful, inflamed lesions in the axillae, groin, and other parts of the body that contain apocrine glands. The disease is a chronic acneiform infection of the cutaneous apocrine glands that also can involve adjacent subcutaneous tissue and fascia. The hallmark of the disease is sinus tracts (which can become draining fistulas) in the apocrine gland body areas. Velpeau first described the condition in 1839.

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Pathophysiology

The condition has classically been thought to occur when apocrine gland outlets become blocked by perspiration or are unable to drain normally because of incomplete gland development. Secretions trapped in the glands force perspiration and bacteria into surrounding tissue, causing subcutaneous induration, inflammation, and infection. However, more recent studies have indicated that hidradenitis suppurativa is caused by follicular occlusion first, which, in turn, occludes the apocrine glands and causes perifolliculitis. Therefore, it is actually a disorder of the terminal follicular epithelium located in the apocrine gland-bearing skin areas, which may better be termed as acne inversa.[1]

Hidradenitis suppurativa is confined to areas of the body that contain apocrine glands. These areas are the axillae, areola of the nipple, groin, perineum, circumanal, and periumbilical regions.

Often, patients with hidradenitis suppurativa also are afflicted with acne, pilonidal cysts, and chronic scalp folliculitis; thus, giving rise to the term follicular occlusion tetrad.

For further information, see Hidradenitis Suppurativa in the Dermatology section and Hidradenitis Suppurativa in the General Surgery section.

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Epidemiology

Frequency

United States

The problem is somewhat common, thought to occur in 1-2% of the population, but the precise incidence and prevalence are unknown.

International

A Danish study noted the prevalence of hidradenitis suppurativa to be in 4% of women.[2]

Mortality/Morbidity

Hidradenitis suppurativa is painful and can be disabling but is rarely fatal, except when it progresses to overwhelming systemic infection in an immunocompromised patient. Extensive disease can prevent patients from performing normal work functions and from engaging in normal social activities. In some patients, especially those with severe disease, the condition creates significant psychological problems, particularly regarding sexual relationships.

Race

Ingrown hairs are a predisposing factor, thus an increased incidence of the disease occurs in patients with tightly curled hair.

Sex

The incidence of hidradenitis suppurativa is greater in females than in males, thought to be in the range of 4:1 or 5:1. Flare-ups have been associated with menses, with a higher incidence in females with shorter cycles and more days of bleeding during the period.[3]

Age

Hidradenitis suppurativa does not present prior to puberty because the apocrine glands are inactive until triggered by a surge in sex hormones. The condition may be observed in patients of any age after puberty.

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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].

  3. Shah N. Hidradenitis suppurativa: a treatment challenge. Am Fam Physician. Oct 15 2005;72(8):1547-52. [Medline]. [Full Text].

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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. 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].

  7. 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].

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

  9. Edlich RF, Silloway KA, Rodeheaver GT, Cooper PH. Epidemiology, pathology, and treatment of axillary hidradenitis suppurativa. J Emerg Med. 1986;4(5):369-78. [Medline].

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  14. König A, Lehmann C, Rompel R, Happle R. Cigarette smoking as a triggering factor of hidradenitis suppurativa. Dermatology. 1999;198(3):261-4. [Medline].

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

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

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

  18. Radcliffe KW. Hidradenitis suppurativa. Genitourin Med. Feb 1991;67(1):58. [Medline].

  19. Rayner CR. Pathogenesis, clinical features and management of hidradenitis suppurativa. Ann R Coll Surg Engl. Jul 1997;79(4):309. [Medline].

  20. Rorison P, Ghosh M. Pathogenesis, clinical features and management of hidradenitis suppurativa. Ann R Coll Surg Engl. Sep 1997;79(5):385. [Medline].

  21. Thomas R, Barnhill D, Bibro M, Hoskins W. Hidradenitis suppurativa: a case presentation and review of the literature. Obstet Gynecol. Oct 1985;66(4):592-5. [Medline].

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  23. 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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