Download PDF
Clin Colon Rectal Surg 2001; 14(3): 233-242
DOI: 10.1055/s-2001-16551
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Hidradenitis Suppurativa

Marc Singer, José R. Cintron
  • Division of Colorectal Surgery, University of Illinois at Chicago, Chicago, IL
Further Information

Publication History

Publication Date:
22 August 2001 (online)

    Permissions and Reprints

ABSTRACT

Hidradenitis suppurativa is a chronic inflammatory disorder of the apocrine sweat gland-bearing skin. The progressive nature of the disease can make it extremely painful and severely debilitating. Traditionally, the etiology of the disorder was believed to be occlusion of the apocrine ducts. However, recent studies suggest that follicular occlusion is the initiating event. The most common sites of the disease are the axilla, perineum, external genitalia, and inguinal regions. Medical management may afford temporary relief of symptoms; however, most patients will eventually require surgical therapy. Incision and drainage or unroofing of sinuses may provide relief in select patients but should be reserved for early and acute disease. Local excisions will provide adequate control of symptoms; however, greater than 50% recurrence can be anticipated. Wide excision with secondary granulation of perineal wounds will provide the most definitive therapy and can be accomplished safely. Perianal disease can more often be managed with local excision alone as recurrence rates of perianal disease are considerably lower than perineal disease.

KEYWORD

Hidradenitis suppurativa - Verneuil's disease - apocrine - perineal disease - perianal disease

REFERENCES

  • 1 Velpeau A. Aissele, Dictionnaire de Medicine, on Repertoire General des Sciences Medicales sons le Rapport Theorique et Pratique (Behcet Jeune Z ed).  . 1839;  2 91
    PubMedGoogle Scholar
  • 2 Verneuil A. Etudes sur les tumeurs de la peau et quelques maladies des glandes sudoripares.  Arch Gen Med . 1854;  94 693-705
    PubMedGoogle Scholar
  • 3 Schiefferdecker B. . In: Die Hautdrusen des Menschen, und der Saugetiere, ihre Histologische und rassenanatomische Bedeutung Sowie die Muscularis Sexualis Stuttgart: E Schweizerbart; 1922
  • 4 Brunsting H A. Hidradenitis suppurativa: abscess of the apocrine sweat glands.  Arch Dermatol Syphil . 1939;  39 108-120
    PubMedGoogle Scholar
  • 5 Morgan W P, Hughes L E. The distribution, size and density of the apocrine glands in hidradenitis suppurativa.  Br J Surg . 1979;  66 853-856
    PubMedGoogle Scholar
  • 6 Shelley W B, Cahn M M. The pathogenesis of hidradenitis suppurativa in man.  Arch Dermatol Syphil . 1955;  72 562-565
    PubMedGoogle Scholar
  • 7 Yu C CW, Cook M G. Hidradenitis suppurativa: a disease of follicular epithelium, rather than apocrine glands.  Br J Dermatol . 1990;  122 763-769
    CrossrefPubMedGoogle Scholar
  • 8 Attanoos R L, Appleton M AC, Douglas-Jones A G. The pathogenesis of hidradenitis suppurativa: a closer look at apocrine and apoeccrine glands.  Br J Dermatol . 1995;  133 254-258
    CrossrefPubMedGoogle Scholar
  • 9 Jemec G BE, Hansen U. Histology of hidradenitis suppurativa.  J Am Acad Dermatol . 1996;  34 994-999
    CrossrefPubMedGoogle Scholar
  • 10 Jansen T, Plewig G. Acne Inversa.  Int J Dermatol . 1998;  37 96-100
    CrossrefPubMedGoogle Scholar
  • 11 Boer J, Weltevreden E F. Hidradenitis suppurativa. A clinicopathological study of early lesions.  Br J Dermatol . 1996;  135 721-725
    PubMedGoogle Scholar
  • 12 Parks R W, Parks T G. Pathogenesis, clinical features and management of hidradenitis suppurativa.  Ann R Coll Surg Engl . 1997;  79 83-39
    PubMedGoogle Scholar
  • 13 Highet A S, Warren R E, Weekes A J. Bacteriology and antibiotic treatment of perineal suppurativa hidradenitis.  Arch Dermatol . 1988;  124 1047-1051
    CrossrefPubMedGoogle Scholar
  • 14 Ebling F J. Apocrine glands in health and disorder.  Int J Dermatol . 1989;  28 508-511
    PubMedGoogle Scholar
  • 15 Rubin R G, Chinn B T. Perianal hidradenitis suppurativa.  Surg Clin North Am . 1994;  74 1317-1325
    PubMedGoogle Scholar
  • 16 Keighley M R, Wiilliams M S. Surgery of the Anus, Rectum and Colon, 2nd ed. London: WB Saunders; . 1999: 456-465
    Google Scholar
  • 17 Wiltz O, Schoetz D J, Murray J J. Perianal hidradenitis suppurativa. The Lahey Clinic experience.  Dis Colon Rectum . 1990;  33 731-734
    CrossrefPubMedGoogle Scholar
  • 18 Broadwater J R, Bryant R L, Petrino R A. Advanced hidradenitis suppurativa: review of surgical treatment in 23 patients.  Am J Surg . 1982;  144 668-670
    CrossrefPubMedGoogle Scholar
  • 19 Rogers I W, Ryan R F. Surgical treatment of hidradenitis suppurativa.  J La State Med Soc . 1983;  10 21-24
    PubMedGoogle Scholar
  • 20 Morgan W P. The role of depilation and deodorants in hidradenitis suppurativa.  Arch Dermatol . 1982;  118 101-102
    CrossrefPubMedGoogle Scholar
  • 21 Fitzsimmons J S, Fitzsimmons E M, Gilbert G. Familial hidradenitis suppurativa: evidence in favour of single gene transmissions.  J Med Genet . 1984;  21 281-285
    PubMedGoogle Scholar
  • 22 Fitzsimmons J S, Gilbert G. A family study of hidradenitis suppurativa.  J Med Genet . 1985;  22 367-373
    PubMedGoogle Scholar
  • 23 Fitzimmons J S, Guilbert P R, Fitzimmons E M. Evidence of genetic factors in hidradenitis suppurativa.  Br J Dermatol . 1985;  113 1-8
    PubMedGoogle Scholar
  • 24 Jemec G BE, Heidenheim M, Nielsen N H. The prevalence of hidradenitis suppurativa and its potential precursor lesions.  J Am Acad Dermatol . 1996;  35 191-194
    CrossrefPubMedGoogle Scholar
  • 25 Von Der Werth M J, Willimas H C, Raeburn J A. The clinical genetics of hidradenitis suppurativa revisited. Br J Dermatol .  2000;  142 947-953
    PubMedGoogle Scholar
  • 26 Stellon A J, Wakeling M. Hidradenitis suppurativa associated with use of oral contraceptives.  Br Med J . 1989;  298 28-29
    PubMedGoogle Scholar
  • 27 Banerjee A K. Surgical treatment of hidradenitis suppurativa.  Br J Surg . 1992;  79 863-866
    CrossrefPubMedGoogle Scholar
  • 28 Jemec G BE. The symptomatology of hidradenitis suppurativa in women.  Br J Dermatol . 1988;  119 345-350
    CrossrefPubMedGoogle Scholar
  • 29 Harrison B J, Kumar S, Read G F. Hidradenitis suppurativa: evidence for an endocrine abnormality.  Br J Surg . 1985;  72 1002-1004
    CrossrefPubMedGoogle Scholar
  • 30 Ebling F JG. Hidradenitis suppurativa: an androgen-dependent disorder.  Br J Dermatol . 1986;  115 259-262
    PubMedGoogle Scholar
  • 31 Lewis F, Messenger A G, Wales J KH. Hidradenitis suppurativa as a presenting feature of premature adrenarche.  Br J Dermatol . 1993;  129 447-448
    PubMedGoogle Scholar
  • 32 Chalmers R JG, Ea R D, Beck M H. Acne vulgaris and hidradenitis suppurativa as presenting features of acromegaly.  Br Med J . 1983;  287 1346-1347
    PubMedGoogle Scholar
  • 33 Curtis A C. Cushing's syndrome and hidradenitis suppurativa.  Arch Dermatol Syph . 1950;  62 329-330
    PubMedGoogle Scholar
  • 34 Thornton J P, Abcarian H. Surgical treatment of perianal and perineal hidradenitis suppurativa.  Dis Colon Rectum . 1978;  21 573-577
    CrossrefPubMedGoogle Scholar
  • 35 Brown S C, Kazzazi N, Lord P H. Surgical treatment of perineal hidradenitis suppurativa with special reference to recognition of the perianal form.  Br J Surg . 1986;  73 978-980
    CrossrefPubMedGoogle Scholar
  • 36 Rompel R, Petres J. Long-term results of wide surgical excision in 106 patients with hidradenitis suppurativa.  Dermatol Surg . 2000;  26 638-643
    CrossrefPubMedGoogle Scholar
  • 37 Lookingbill D P. Yield from a complete skin examination.  J Am Acad Dermatol . 1988;  18 31-37
    PubMedGoogle Scholar
  • 38 Cornbleet T. Pregnancy and apocrine gland disease: hidradenitis and Fox-Fordyce disease.  AMA Arch Dermatol Syph . 1952;  65 12-19
    PubMedGoogle Scholar
  • 39 Mengesha Y M, Holcombe T C, Hansen R C. Prepubertal hidradenitis suppurativa: two case reports and review of the literature.  Pediatr Dermatol . 1999;  16 292-296
    CrossrefPubMedGoogle Scholar
  • 40 Harrison B H, Kumar S, Read G F. Recurrence after surgical treatment of hidradenitis suppurativa.  Br Med J Clin Res . 1987;  294 487-489
    CrossrefPubMedGoogle Scholar
  • 41 Culp C E. Chronic hidradenitis suppurativa of the anal canal: a surgical skin disease.  Dis Colon Rectum . 1983;  26 669-675
    CrossrefPubMedGoogle Scholar
  • 42 Endo Y, Tamura A, Ishikawa O. Perianal hidradenitis suppurativa: early surgical treatment gives good results in chronic or recurrent cases.  Br J Dermatol . 1998;  139 960-910
    PubMedGoogle Scholar
  • 43 Burrows N P, Jones R R. Crohn's disease in association with hidradenitis suppurativa.  Br J Dermatol . 1992;  126 523
    PubMedGoogle Scholar
  • 44 Gower-Rousseau C, Maunoury V, Colombel J F. Hidradenitis suppurativa and Crohn's disease in two families: a significant association?.  Am J Gastroenterol . 1992;  87 928
    PubMedGoogle Scholar
  • 45 Church J M, Fazio V W, Lavery I C. The differential diagnosis and comorbidity of hidradenitis suppurativa and perianal Crohn's disease.  Int J Colorectal Dis . 1993;  8 117-119
    PubMedGoogle Scholar
  • 46 Self S J, Montes L FL. Follicular occlusion triad.  South Med J . 1979;  63 156-160
    PubMedGoogle Scholar
  • 47 Ramasastry S S, Conklin W T, Granick M S. Surgical management of massive perianal hidradenitis suppurativa.  Ann Plast Surg . 1985;  15 218-223
    CrossrefPubMedGoogle Scholar
  • 48 Moschella S A. Hidradenitis suppurativa: complications resulting in death.  JAMA . 1966;  198 201-204
    CrossrefPubMedGoogle Scholar
  • 49 Grassi W, Offidani A M, Blasetti P. HLA-B27 negative ankylosing spondylitis and hidradenitis suppurativa: report of a case.  Clin Rheumatol . 1988;  7 278-283
    PubMedGoogle Scholar
  • 50 Vasey F B, Fenske N A, Clement G B. Immunological studies of the arthritis of acne conglobata and hidradenitis suppurativa.  Clin Exp Rheumatol . 1984;  2 309-311
    PubMedGoogle Scholar
  • 51 Rosner I A, Burg C G, Wisnieski J J. The clinical spectrum of the arthropathy associated with hidradenitis suppurativa and acne conglobata.  J Rheumatol . 1993;  20 684-687
    PubMedGoogle Scholar
  • 52 Bhalla R, Sequeira W. Arthritis associated with hidradenitis suppurativa.  Ann Rheum Dis . 1994;  53 64-66
    PubMedGoogle Scholar
  • 53 Rosner I A, Richter D E, Huettner T L. Spondyloarthropathy associated with hidradenitis suppurativa and acne conglobata.  Ann Intern Med . 1982;  97 520-525
    PubMedGoogle Scholar
  • 54 Jackman R J. Hidradenitis suppurativa: diagnosis and management of perianal manifestations.  Proc R Soc Med . 1959;  52 110-112
    PubMedGoogle Scholar
  • 55 Perez-Diaz D, Calvo-Serrano M, Martinez-Hijosa E. Squamous cell carcinoma complicating perianal hidradenitis suppurativa.  Int J Colorectal Dis . 1995;  10 225-228
    CrossrefPubMedGoogle Scholar
  • 56 Bendehan J, Paran H, Kolman S. The possible role of Chlamydia trachomatis in perineal suppurativa hidradenitis.  Eur J Surg . 1992;  158 213-215
    PubMedGoogle Scholar
  • 57 Baron E J, Curren M, Henderson G. Bilophila wadsworthia isolates from clinical specimens.  J Clin Microbiol . 1992;  30 1882-1884
    PubMedGoogle Scholar
  • 58 Clemmensen O J. Topical treatment of hidradenitis suppurativa with clindamycin.  Int J Dermatol . 1983;  22 325
    CrossrefPubMedGoogle Scholar
  • 59 Jemec G BE, Wendelboe P. Topical clinidamycin versus systemic tetracycline in the treatment of hidradentisi suppurativa.  J Am Acad Dermatol . 1998;  39 971-974
    CrossrefPubMedGoogle Scholar
  • 60 Ostlere L S, Langtry J A, Mortimer P S. Hidradenitis suppurativa in Crohn's disease.  Br J Dermatol . 1991;  125 384-386
    PubMedGoogle Scholar
  • 61 Camisa C, Sexton C, Friedman C. Treatment of hidradenitis suppurativa with combination hypothalamic-pituitary-ovarian and adrenal suppression. A case report.  J Reprod Med . 1989;  24 543-546
    PubMedGoogle Scholar
  • 62 Sawers R S, Randall V A, Ebling F J. Control of hidradenitis suppurativa in women using combined antiandrogen (cyproterone acetate) and oestrogen therapy.  Br J Dermatol . 1986;  115 269-274
    CrossrefPubMedGoogle Scholar
  • 63 Mortimer P S, Dawber R P, Gales M A. A double-blind controlled cross-over trial of cyproterone acetate in females with hidradenitis suppurativa.  Br J Dermatol . 1986;  115 263-268
    CrossrefPubMedGoogle Scholar
  • 64 Brown C G, Gallup D G, Brown V M. Hidradenitis suppurativa of the anogenital region: response to isotretinoin.  Am J Obstet Gynecol . 1988;  158 12-15
    PubMedGoogle Scholar
  • 65 Hogan D J, Light M J. Successful treatment of hidradenitis suppurativa with acitretin.  J Am Acad Dermatol . 1988;  19 355-356
    PubMedGoogle Scholar
  • 66 Stewart W D, Light M J. Successful treatment of hidradenitis suppurativa with etretinate.  Dermatologica . 1984;  169 258
    PubMedGoogle Scholar
  • 67 Chow E TY, Mortimer P S. Successful treatment of hidradenitis suppurativa and retroauricular acne with etretinate.  Br J Dermatol . 1992;  126 415
    PubMedGoogle Scholar
  • 68 Vahlquist A, Griffiths W AS. Retinoid therapy in hidradenitis suppurativa-a report of a case.  Retinoids Today Tomorrow . 1992;  18 28-30
    PubMedGoogle Scholar
  • 69 Gupta A K, Ellis C N, Nickoloff B J. Oral cyclosporine in the treatment of inflammatory and noninflammatory dermatoses. A clinical and immunopathologic analysis.  Arch Dermatol . 1990;  126 339-350
    CrossrefPubMedGoogle Scholar
  • 70 Jemec G B. Effect of localized surgical excisions in hidradenitis suppurativa.  J Am Acad Dermatol . 1988;  18 1103-1107
    PubMedGoogle Scholar
  • 71 Paletta C, Jurkiewicz M J. Hidradenitis suppurativa.  Clin Plast Surg . 1987;  14 383-390
    PubMedGoogle Scholar
  • 72 Anderson M J, Docketry M D. Perineal hidradenitis suppurativa.  Dis Colon Rectum . 1958;  1 23-31
    CrossrefPubMedGoogle Scholar
  • 73 Watson J D. Hidradenitis suppurativa-a clinical review.  Br J Plast Surg . 1985;  38 567-569
    CrossrefPubMedGoogle Scholar
  • 74 Williams S T, Busby R C, De Muth J R. Perineal hidradenitis suppurativa: presentation of two unusual complications and a review.  Ann Plast Surg . 1991;  26 456-462
    CrossrefPubMedGoogle Scholar
  • 75 Knaysi G A, Socman F, Crickelair G F. Hidradenitis suppurativa.  JAMA . 1968;  203 19
    CrossrefPubMedGoogle Scholar
  • 76 Shaughnessey D M, Greminger R R, Margolis I B. Hidradenitis suppurativa: a plea for early operative treatment.  JAMA . 1972;  222 320-321
    CrossrefPubMedGoogle Scholar
  • 77 Conway H, Stark R B, Climos S. The surgical treatment of chronic hidradenitis suppurativa.  Surg Gynecol Obstet . 1952;  95 455-464
    PubMedGoogle Scholar
  • 78 Ritz J P, Runkel N, Haier J, Buhr H J. Extent of surgery and recurrence rate of hidradenitis suppurativa.  Int J Colorect Dis . 1998;  13 164-168
    CrossrefPubMedGoogle Scholar
  • 79 Weinzweig N. Hidradenitis Suppurativa. In: Cohen M, ed. Mastery of Plastic and Reconstructive Surgery New York: Little, Brown and Company 1994: 384-395
    Google Scholar
  • 80 Mason J K. Surgical treatment for hidradenitis suppurativa.  Surg Clin North Am . 1969;  49 1043-1052
    PubMedGoogle Scholar
  • 81 Silverberg B, Smoot C E, Landa S J. Hidradenitis suppurativa: patient satisfaction with wound healing by secondary intention.  Plast Reconstruc Surg . 1987;  79 555-559
    PubMedGoogle Scholar
      >