​Dermatology - Hidradenitis Suppurativa

​Dermatology - Hidradenitis Suppurativa 
After puberty,hidradenitis suppurativa strikes, affecting women more frequently than men (about 4% of women). Men are more likely to experience anogenital involvement than women are axillary involvement. Predispositions include smoking, obesity, and a family history of HS or acne.

varies in severity from tiny red nodules that heal on their own to significant morbidity brought on by persistent discomfort, draining sinuses, scarring, and limited movement. Ages over 35 are typically when spontaneous remission occurs, however they don't always.

Open and double comedones evolve into extremely sensitive, red, inflamed nodules or abscesses that drain or resolve purulent or seropurulent material, leading to the development of sensitive sinus tracts. Fibrosis, "bridge" scars, hypertrophic and keloidal scars, contractures, and in rare cases, lymphedema of the related limb come next. The axillae, breasts, anogenital region, and groin are the common locations for lesions, which can also affect the scalp, buttocks, perineum involving the scrotum or vulva, and entire back. Lesions are frequently bilateral.

The differential diagnosis consists of furuncle, carbuncle, lymphadenitis, ruptured inclusion cyst, lymphogranuloma venereum, also known as cat-scratch disease, actinomycosis, donovanosis, scrofuloderma, ulcerative colitis, and regional enteritis. The diagnosis is clinical.

The treatment for this condition includes intralesional glucocorticoids, surgery, isotretinoin, and systemic antibiotics such as erythromycin (250–500 mg four times a day), tetracycline (250–500 mg four times a day), minocycline (100 mg twice a day), or clindamycin (300 mg twice a day), along with rifampin (300 mg twice a day). Triamcinolone (3–5 mg/mL) injected intralesionally, followed by incision and drainage, is used to treat painful nodules and abscesses. Remove and drain any persistent, recurrent fibrotic nodules or sinus tracts; split skin grafting may be required for the full excision of the axilla or other affected anogenital region. Use 70 mg of prednisone per day for two to three days, tapering over a period of 14 days, for severe discomfort and inflammation. Oral isotretinoin may avoid follicular plugging even if it is ineffective in cases of severe illness and should be taken in conjunction with surgical excision. Depression is widespread and has to be managed.