View source for Hidradenitis suppurativa

{{short description|Human disease}}
{{Redirect|Suppurativa|acrodermatitis continua suppurativa|Dermatitis repens}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Infobox medical condition (new)
| name          = Hidradenitis suppurativa
| synonyms      = Acne inversa, apocrine acne, Verneuil's disease, Velpeau's disease<ref name=NORD2012 />
| image         = Hidradenitis suppurativa (stage II) in axilla.jpg
| caption       = Hidradenitis suppurativa (Hurley's stage II) in the left armpit
| field         = [[Dermatology]]
| symptoms      = Multiple inflamed and swollen skin [[lesions]]<ref name=NEJM2012 />
| complications = 
| onset         = Childhood and Young adulthood<ref name=NEJM2012 />
| duration      = Long-term<ref name=NEJM2012 />
| types         = Stage I, II, III<ref name=NORD2012 />
| causes        = Unknown<ref name=GHR2013 />
| risks         = 
| diagnosis     = Based on symptoms<ref name=NEJM2012 />
| differential  = [[Acne]], [[acne conglobata]], [[pilonidal cysts]]<ref name=NEJM2012 />
| prevention    = 
| treatment     = Warm baths, [[laser therapy]], surgery<ref name=NEJM2012 /><ref name=GARD2017 />
| medication    = [[Secukinumab]], [[antibiotics]], [[immunosuppressive medication]]<ref name=NEJM2012 />
| prognosis     = 
| frequency     = 1–4% of people, when mild cases are included<ref name=NEJM2012 /><ref name=GHR2013 />
| deaths        = Rare<ref name=NORD2012 />
| alt           = 
}}
[[File:Hidradenitis.png|thumb|A case of hidradenitis suppurativa]]
[[File:Hidradenitis Growths.jpg|thumb|Hidradenitis suppurativa can take the form of growths on the skin that are extremely painful and debilitating.]]<!-- Definition and symptoms -->
'''Hidradenitis suppurativa''' ('''HS'''), sometimes known as '''acne inversa''' or '''Verneuil's disease''', is a long-term [[dermatological]] condition characterized by the occurrence of inflamed and swollen [[lesions|lumps]].<ref name="NEJM2012">{{cite journal | vauthors = Jemec GB | title = Clinical practice. Hidradenitis suppurativa | journal = The New England Journal of Medicine | volume = 366 | issue = 2 | pages = 158–64 | date = January 2012 | pmid = 22236226 | doi = 10.1056/NEJMcp1014163 }}</ref><ref name="GHR2013">{{cite web|title=Hidradenitis suppurativa|url=https://medlineplus.gov/genetics/condition/hidradenitis-suppurativa/|website=Genetics Home Reference|access-date=27 October 2017|language=en|date=December 2013|url-status=live|archive-url=https://web.archive.org/web/20170905190522/https://ghr.nlm.nih.gov/condition/hidradenitis-suppurativa|archive-date=5 September 2017}}</ref> These are typically painful and break open, releasing fluid or [[pus]].<ref name="GHR2013" /> The areas most commonly affected are the [[axilla|underarms]], [[inframammary fold|under the breasts]], [[perineum]], [[buttocks]], and the [[groin]].<ref name="NORD2012">{{cite web|title=Hidradenitis Suppurativa|url=https://rarediseases.org/rare-diseases/hidradenitis-suppurativa/|website=NORD (National Organization for Rare Disorders)|access-date=26 October 2017|date=2012|archive-url=https://web.archive.org/web/20170219163032/https://rarediseases.org/rare-diseases/hidradenitis-suppurativa/|archive-date=19 February 2017}}</ref> [[Scar]] tissue remains after healing.<ref name="NORD2012" /> HS may significantly limit many everyday activities, for instance, walking, hugging, moving, and sitting down. [[Sitting disability]] may occur in patients with lesions in the sacral, gluteal, perineal, femoral, groin or genital regions. Prolonged periods of sitting down can also worsen the condition of the skin of these patients.<ref>{{cite web|url=https://www.ingentaconnect.com/contentone/mjl/adv/2019/00000099/f0020001/art00024?crawler=true&mimetype=application/pdf|title=Intergluteal contour deformity in hidradenitis suppurativa |access-date=18 May 2021}}</ref><ref>{{cite journal|url=https://onlinelibrary.wiley.com/doi/pdf/10.1111/srt.12729|title=Color Doppler as a tool for correlating vascularization and pain in hidradenitis suppurativa lesions|year=2019|doi=10.1111/srt.12729|access-date=18 May 2021|last1=Nazzaro|first1=Gianluca|last2=Passoni|first2=Emanuela|last3=Calzari|first3=Paolo|last4=Barbareschi|first4=Mauro|last5=Muratori|first5=Simona|last6=Veraldi|first6=Stefano|last7=Marzano|first7=Angelo Valerio|journal=Skin Research and Technology|volume=25|issue=6|pages=830–834|pmid=31140660|s2cid=169036038|url-access=subscription}}</ref><ref>{{cite journal|url=https://www.karger.com/Article/FullText/501611|title=Undergarment and fabric selection in the management of hidradenitis suppurativa|year=2021|doi=10.1159/000501611|access-date=18 May 2021|last1=Loh|first1=Tiffany Y.|last2=Hendricks|first2=Aleksi J.|last3=Hsiao|first3=Jennifer L.|last4=Shi|first4=Vivian Yan|journal=Dermatology|volume=237|issue=1|pages=119–124|pmid=31466052|s2cid=201672889|doi-access=free}}</ref><ref>{{cite journal|url=https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2230.1996.tb00145.x|title=Hidradenitis suppurativa-characteristics and consequences|year=1996|doi=10.1111/j.1365-2230.1996.tb00145.x|access-date=18 May 2021|last1=Jemec|first1=G.B.E.|last2=Heidenheim|first2=M.|last3=Nielsen|first3=N.H.|journal=Clinical and Experimental Dermatology|volume=21|issue=6|pages=419–423|pmid=9167336|s2cid=25491238|url-access=subscription}}</ref><ref>{{cite web|url=https://www.ingentaconnect.com/contentone/mjl/adv/2011/00000091/00000003/art00014?crawler=true&mimetype=application/pdf
|title=Psychosocial impact of hidradenitis suppurativa: a qualitative study|access-date=18 May 2021}}</ref>

<!-- Cause and diagnosis -->
The exact cause is usually unclear but believed to involve a combination of [[Genetics|genetic]] and environmental factors.<ref name="GHR2013" /> About a third of people with the disease have an affected family member.<ref name="GHR2013" /> Other risk factors include [[obesity]] and [[smoking]].<ref name="GHR2013" /> The condition is not caused by an [[infection]], poor [[hygiene]], or the use of [[deodorant]].<ref name="GHR2013" /><ref name="GARD2017">{{cite web|title=Hidradenitis suppurativa|url=https://rarediseases.info.nih.gov/diseases/6658/hidradenitis-suppurativa|website=rarediseases.info.nih.gov|access-date=27 October 2017|language=en|date=2017|archive-url=https://web.archive.org/web/20170728010703/https://rarediseases.info.nih.gov/diseases/6658/hidradenitis-suppurativa/|archive-date=28 July 2017}}</ref> Instead, it is believed to be caused by [[hair follicles]] being obstructed,{{refn|See section "Genetic Changes"<ref name=GHR2013 />}}<ref name="NORD2012" /> with the nearby [[apocrine sweat glands]] being strongly implicated in this obstruction.<ref name="NORD2012" /><ref name="2017-NCBI-SeminalSummary">[https://pubmed.ncbi.nlm.nih.gov/28538743/ Pathophysiology of hidradenitis suppurativa] (Seminal paper, SCMS Journal); ''NIH, National Library of Medicine, NCBI''; 2017 Jun, 36(2):47–54.</ref> The sweat glands may or may not be inflamed.<ref name="NORD2012" /> Diagnosis is based on the symptoms.<ref name="NEJM2012" />

<!-- Treatment and prognosis -->
No cure is known,<ref name="GARD2017" /> though surgical excision with wet-to-dry dressings, proper wound care, and warm baths or showering with a pulse-jet shower may be used in those with mild disease.<ref name="GARD2017" /> Cutting open the lesions to allow them to drain does not result in significant benefit.<ref name="NEJM2012" /> While [[antibiotics]] are commonly used, evidence for their use is poor.<ref name="GARD2017" /> [[Immunosuppressive medication]] may also be tried.<ref name="NEJM2012" /> In those with more severe disease, [[laser therapy]] or surgery to remove the affected skin may be viable.<ref name="NEJM2012" /> Rarely, a skin lesion may develop into [[skin cancer]].<ref name="GHR2013" />

<!-- Epidemiology and history -->
If mild cases of HS are included, then the estimate of its frequency is from 1–4% of the population.<ref name="NEJM2012" /><ref name="GHR2013" /> Women are three times more likely to be diagnosed with it than men.<ref name="NEJM2012" /> Onset is typically in young adulthood and may become less common after 50 years old.<ref name="NEJM2012" /> It was first described between 1833 and 1839 by French anatomist [[Alfred-Armand-Louis-Marie Velpeau|Alfred Velpeau]].<ref name="NORD2012" /><ref>{{cite book|last1=Jemec|first1=Gregor|last2=Revuz|first2=Jean|last3=Leyden|first3=James J. |title=Hidradenitis Suppurativa|date=2006|publisher=Springer Science & Business Media|isbn=978-3-540-33101-8|page=5|url=https://books.google.com/books?id=hpKFsXwcKlgC&pg=PA5|language=en|url-status=live|archive-url=https://web.archive.org/web/20171028043436/https://books.google.ca/books?id=hpKFsXwcKlgC&pg=PA5|archive-date=28 October 2017}}</ref>

== Terminology ==
Although hidradenitis suppurativa is often called acne inversa, it is not a form of acne. Hidradenitis suppurativa lacks the core defining features of acne, such as the presence of closed [[comedone]]s and increased [[sebum]] production.<ref name="Dessinioti2014">{{cite journal |vauthors=Dessinioti C, Katsambas A, Antoniou C |date=May–June 2014 |title=Hidradenitis suppurrativa (acne inversa) as a systemic disease |journal=Clinics in Dermatology |volume=32 |issue=3 |pages=397–408 |doi=10.1016/j.clindermatol.2013.11.006 |pmid=24767187}}</ref>

== Causes ==
The exact cause of hidradenitis suppurativa remains unknown,<ref name="2017-NCBI-SeminalSummary" /><!--There is an identical copy of the following ref (refn to be exact I guess) in the lede (under 'Causes and Diagnoses') - I'm not sure if is possible to name the nested ref.-->{{refn|See section "Genetic Changes"<ref name=GHR2013 />}} and there has, in the recent past, been notable disagreement among experts in this regard.<ref name="medline">{{cite web |url=https://www.medlineplus.gov/hidradenitissuppurativa.html |title=Hidradenitis suppurativa |author=Medline Plus |year=2012 |publisher=U.S. National Library of Medicine |access-date=19 September 2012 |url-status=live |archive-url=https://web.archive.org/web/20120916230638/http://www.nlm.nih.gov/medlineplus/hidradenitissuppurativa.html |archive-date=16 September 2012  }}</ref> The condition, however, likely stems from both genetic and environmental causes.<ref name="GHR2013" /> Specifically, an immune-mediated pathology has been proposed,<ref name="2017-NCBI-SeminalSummary" /> although environmental factors have not been ruled out.<ref name="GHR2013" /><!--One of us should probably figure out how to ref the nested GHR2013 cite-->

Lesions will occur in any body area with hair follicles,<ref name="medline" /> and/or sweat glands.<ref>{{cite web |url= https://www.hopkinsmedicine.org/health/conditions-and-diseases/hidradenitis-suppurativa |title=Inflamed/Infected Sweat Glands (Hidradenitis) |author=Hopkins Medicine Staff |year=2024 |publisher=Johns Hopkins Medicine |access-date=27 March 2024}}</ref> Areas such as the axilla, groin, and perineal region are more commonly involved. This theory includes most of these potential indicators:<ref name="Schawartzprinciples">Schawartz's Principles of Surgery, 8th edition, self-assessment, and board review, chapter 15, the skin and subcutaneous tissue, question 16</ref>
* Post-pubescent individuals<ref>{{cite web |url=http://www.mayoclinic.com/health/hidradenitis-suppurativa/DS00818 |title=Definition |author=Mayo Clinic Staff |year=2012 |publisher=Mayo Clinic |access-date=19 September 2012 |url-status=live |archive-url=https://web.archive.org/web/20120910150727/http://www.mayoclinic.com/health/hidradenitis-suppurativa/DS00818 |archive-date=10 September 2012  }}</ref>
* Blocked hair follicles or blocked [[apocrine sweat gland]]s
* [[Primary hyperhidrosis|Excessive sweating]]
* [[Androgen]] dysfunction
* [[Genetic disorder]]s that alter [[cell (biology)|cell]] structure

The historical understanding of the disease suggests dysfunctional apocrine glands<ref name="dermnetnz" /> or dysfunctional hair follicles,<ref>{{cite web|url=http://www.hs-foundation.org/abouths/what.htm |title=HSF – What is Hidradenitis Suppurativa? What is HS? |access-date=2007-07-08 |archive-url=https://web.archive.org/web/20070706084625/http://www.hs-foundation.org/abouths/what.htm |archive-date=6 July 2007  }}</ref> possibly triggered by a blocked gland, which creates [[inflammation]], [[pain]], and a swollen [[lesion]].

=== Triggering factors ===

Several triggering factors should be taken into consideration:
* [[Obesity]]<ref name="ReferenceB">{{cite journal | vauthors = Slade DE, Powell BW, Mortimer PS | title = Hidradenitis suppurativa: pathogenesis and management | journal = British Journal of Plastic Surgery | volume = 56 | issue = 5 | pages = 451–61 | date = July 2003 | pmid = 12890458 | doi = 10.1016/S0007-1226(03)00177-2 | doi-access = free }}</ref> is an exacerbating rather than a triggering factor,<ref name="Jemec GBE 1989. p. 375-6">Jemec GBE. Body weight in hidradenitis suppurativa. In: Marks R, Plewig G, editors. Acne and Related Disorders. London: Martin Dunitz; 1989. pp. 375–6.</ref> through mechanical [[irritation]], [[occlusion miliaria|occlusion]], and [[skin maceration]].
* Tight clothing,<ref name="ReferenceB" /> and clothing made of heavy, nonbreathable materials<ref>{{cite journal | vauthors = König A, Lehmann C, Rompel R, Happle R | title = Cigarette smoking as a triggering factor of hidradenitis suppurativa | journal = Dermatology | volume = 198 | issue = 3 | pages = 261–4 | year = 1999 | pmid = 10393449 | doi = 10.1159/000018126 | s2cid = 25343489 }}</ref>
* [[Deodorants]], [[depilation]] products, [[shaving]] of the affected area – their association with HS is still an ongoing debate among researchers.<ref name="pmid509057">{{cite journal | vauthors = Morgan WP, Hughes LE | title = The distribution, size and density of the apocrine glands in hidradenitis suppurativa | journal = The British Journal of Surgery | volume = 66 | issue = 12 | pages = 853–6 | date = December 1979 | pmid = 509057 | doi = 10.1002/bjs.1800661206 | s2cid = 46448517 }}</ref>
* [[Drugs]], in particular [[oral contraceptive pill]]s,<ref>{{cite journal | vauthors = Stellon AJ, Wakeling M | title = Hidradenitis suppurativa associated with use of oral contraceptives | journal = BMJ | volume = 298 | issue = 6665 | pages = 28–9 | date = January 1989 | pmid = 2492847 | pmc = 1835363 | doi = 10.1136/bmj.298.6665.28 }}</ref> [[Tobacco smoking|cigarette smoking]],<ref>{{cite journal |last1=Acharya |first1=P |last2=Mathur |first2=M |title=Hidradenitis suppurativa and smoking: A systematic review and meta-analysis. |journal=Journal of the American Academy of Dermatology |date=April 2020 |volume=82 |issue=4 |pages=1006–1011 |doi=10.1016/j.jaad.2019.10.044 |pmid=31678467|s2cid=207889793 }}</ref><ref name="Scala2021">{{cite journal |last1=Scala |first1=E |last2=Cacciapuoti |first2=S |last3=Garzorz-Stark |first3=N |last4=Megna |first4=M |last5=Marasca |first5=C |last6=Seiringer |first6=P |last7=Volz |first7=T |last8=Eyerich |first8=K |last9=Fabbrocini |first9=G |title=Hidradenitis Suppurativa: Where We Are and Where We Are Going. |journal=Cells |date=15 August 2021 |volume=10 |issue=8 |page=2094 |doi=10.3390/cells10082094 |pmid=34440863 |pmc=8392140 |doi-access=free }}</ref> and [[Lithium (medication)|lithium]].<ref>{{cite journal | vauthors = Gupta AK, Knowles SR, Gupta MA, Jaunkalns R, Shear NH | title = Lithium therapy associated with hidradenitis suppurativa: case report and a review of the dermatologic side effects of lithium | journal = Journal of the American Academy of Dermatology | volume = 32 | issue = 2 Pt 2 | pages = 382–6 | date = February 1995 | pmid = 7829746 | doi = 10.1016/0190-9622(95)90410-7 }}</ref>
* Hot and especially [[Humidity|humid]] climates.<ref>{{EMedicine|article|1073117|Hidradenitis Suppurativa}}</ref>
* Stress<ref name="Scala2021" />

=== Predisposing factors ===
* [[genetics|Genetic]] factors:<ref name="Jemec GBE 1989. p. 375-6" /> an [[autosomal dominant]] [[inheritance]] pattern has been proposed.<ref>{{cite journal | vauthors = Von Der Werth JM, Williams HC, Raeburn JA | title = The clinical genetics of hidradenitis suppurativa revisited | journal = The British Journal of Dermatology | volume = 142 | issue = 5 | pages = 947–53 | date = May 2000 | pmid = 10809853 | doi = 10.1046/j.1365-2133.2000.03476.x | s2cid = 35601570 }}</ref>
* [[Endocrine]] factors: 
** Sex hormones, especially an excess of [[androgens]], are thought to be involved, although the apocrine glands are not sensitive to these [[hormones]].<ref>{{cite journal | vauthors = Barth JH, Kealey T | title = Androgen metabolism by isolated human axillary apocrine glands in hidradenitis suppurativa | journal = The British Journal of Dermatology | volume = 125 | issue = 4 | pages = 304–8 | date = October 1991 | pmid = 1954117 | doi = 10.1111/j.1365-2133.1991.tb14162.x | s2cid = 34410437 }}</ref> Women often have outbreaks before their [[menstruation|menstrual period]] and after [[pregnancy]]; HS severity usually decreases during pregnancy and after [[menopause]].
** [[Diabetes mellitus]] is common in hidradenitis suppurativa and seems to be a risk factor.<ref name="AbuRached2023">{{Cite journal |last1=Abu Rached |first1=Nessr |last2=Gambichler |first2=Thilo |last3=Ocker |first3=Lennart |last4=Dietrich |first4=Johannes W. |last5=Quast |first5=Daniel R. |last6=Sieger |first6=Christina |last7=Seifert |first7=Caroline |last8=Scheel |first8=Christina |last9=Bechara |first9=Falk G. |date=2023-04-01 |title=Screening for Diabetes Mellitus in Patients with Hidradenitis Suppurativa—A Monocentric Study in Germany |journal=International Journal of Molecular Sciences |language=en |volume=24 |issue=7 |page=6596 |doi=10.3390/ijms24076596 |issn=1422-0067 |pmc=10094965 |pmid=37047569 |doi-access=free }}</ref>

Some cases have been found to result from mutations in the ''[[NCSTN]]'', ''[[PSEN1]]'', or ''[[PSENEN]]'' genes. The genes produce proteins that are all components of a complex called [[Gamma secretase|gamma- (γ-) secretase]]. This complex cuts apart (cleaves) many different proteins, which is a crucial step in several chemical [[Signal transduction|signaling pathways]]. One of these pathways, known as [[Notch signaling pathway|notch signaling]], is essential for the normal maturation and division of hair follicle cells and other types of skin cells. Notch signaling influences normal [[immune system]] function. Studies suggest mutations in the ''NCSTN'', ''PSEN1'', or ''PSENEN'' genes impair notch signaling in hair follicles. Although little is known about the mechanism, abnormal notch signaling appears to promote the development of nodules and lead to skin inflammation.<ref>{{Cite web|url=https://medlineplus.gov/genetics/condition/hidradenitis-suppurativa/|title=hidradenitis suppurativa|last=Reference|first=Genetics Home|website=Genetics Home Reference|language=en|access-date=2017-09-05|url-status=live|archive-url=https://web.archive.org/web/20170905190522/https://ghr.nlm.nih.gov/condition/hidradenitis-suppurativa|archive-date=5 September 2017}}</ref> In addition,  the composition of the intestinal microflora and as a consequence dietary patterns appear to play a role. Although dysbiosis of the cutaneous microbiome apparent in HS is not observed, the concurrent existence of inflammatory gut and skin diseases has led to the hypothesis of a gut-skin axis in which gut microbiota is implicated. Indeed, analysis of bacterial taxa in fecal samples from HS patients supports the possibility of a role for intestinal microbial alterations in this chronic inflammatory skin disease.<ref>{{cite journal | vauthors = Lam SY, Radjabzadeh D, Eppinga H, Nossent YR, van der Zee HH, Kraaij R, Konstantinov SR, Fuhler SM, Prens EP, Thio HB, PeppelenboschBarth MP | title = A microbiome study to explore the gut-skin axis in hidradenitis suppurativa | journal = Journal of Dermatological Science | volume = 101 | issue = 3 | pages = 218–220 |date = March 2021 | pmid = 33423845  | doi = 10.1016/j.jdermsci.2020.12.008| s2cid = 231576248 | url = https://pure.eur.nl/en/publications/4cd90f98-29e6-48d3-ad90-b16eeb81184f }}</ref>

[[Precocious puberty]] is more common among children and adolescents with hidradenitis suppurativa (HS) compared to those without the condition, according to a recent case-control study.<ref>{{Cite web |date=2024-09-23 |title=Precocious Puberty More Common in Children with Hidradenitis Suppurativa |url=https://www.hcplive.com/view/precocious-puberty-more-common-in-children-with-hidradenitis-suppurativa |access-date=2024-09-28 |website=HCP Live |language=en}}</ref>{{primary source|date=April 2025}} An analysis of the Explorys database revealed that pediatric patients with precocious puberty have double the risk of developing HS, even after adjusting for factors like demographic characteristics and body mass index (BMI).<ref>{{Cite journal |last1=Mastacouris |first1=Nicole |last2=Midgette |first2=Bria |last3=Strunk |first3=Andrew |last4=Garg |first4=Amit |date=2024-09-18 |title=Precocious Puberty Among Children and Adolescents With Hidradenitis Suppurativa |journal=JAMA Dermatology |volume=160 |issue=11 |pages=1245–1246 |doi=10.1001/jamadermatol.2024.3104 |pmid=39292442 |pmc=11411440 |issn=2168-6068}}</ref>

== Diagnosis ==
Early diagnosis is essential in avoiding tissue damage. However, HS is often misdiagnosed or diagnosed late due to healthcare professionals not being aware of the condition or people not consulting with a physician.<ref name=":0">{{Cite journal |date=2022-02-01 |title=People with the skin condition, hidradenitis suppurativa, need earlier diagnoses, more treatment options and wider support |url=https://evidence.nihr.ac.uk/alert/hidradenitis-suppurativa-people-need-earlier-diagnoses-more-treatment-options-wider-support/ |journal=NIHR Evidence |type=Plain English summary |language=en |publisher=National Institute for Health and Care Research |doi=10.3310/alert_48917|s2cid=246548949 |url-access=subscription }}</ref><ref name=":1">{{Cite journal |last1=Howells |first1=L. |last2=Lancaster |first2=N. |last3=McPhee |first3=M. |last4=Bundy |first4=C. |last5=Ingram |first5=J.R. |last6=Leighton |first6=P. |last7=Henaghan-Sykes |first7=K. |last8=Thomas |first8=K.S. |date=29 May 2021 |title=Thematic synthesis of the experiences of people with hidradenitis suppurativa: a systematic review* |url=https://onlinelibrary.wiley.com/doi/10.1111/bjd.20523 |journal=British Journal of Dermatology |language=en |volume=185 |issue=5 |pages=921–934 |doi=10.1111/bjd.20523 |pmid=34050935 |s2cid=235242411 |issn=0007-0963}}</ref> Globally, the diagnosis is delayed more than 7 years in average after symptoms appear. This is much longer than with other skin conditions.<ref>{{Cite journal |last1=Saunte |first1=D.M. |last2=Boer |first2=J. |last3=Stratigos |first3=A. |last4=Szepietowski |first4=J.C. |last5=Hamzavi |first5=I. |last6=Kim |first6=K.H. |last7=Zarchi |first7=K. |last8=Antoniou |first8=C. |last9=Matusiak |first9=L. |last10=Lim |first10=H.W. |last11=Williams |first11=M. |last12=Kwon |first12=H.H. |last13=Gürer |first13=M.A. |last14=Mammadova |first14=F. |last15=Kaminsky |first15=A. |date=21 July 2015 |title=Diagnostic delay in hidradenitis suppurativa is a global problem |url=https://onlinelibrary.wiley.com/doi/10.1111/bjd.14038 |journal=British Journal of Dermatology |language=en |volume=173 |issue=6 |pages=1546–1549 |doi=10.1111/bjd.14038|pmid=26198191 |s2cid=41589200 |url-access=subscription }}</ref>

=== Stages ===
[[File:HS on abdomen.jpg|thumb|Hidradenitis suppurativa stage III on abdomen: Skin is red and inflamed, constantly draining a malodorous blood/pus mixture. Pain is severe.]]
[[File:HS Hidradenitis Suppurativa.jpg|thumb|Hidradenitis suppurativa. This lesion is about 4 inches across.]]
[[File:Micrograph of hidradenitis suppurativa.jpg|thumb|Micrograph of hidradenitis suppurativa: Sinus tracts [(A), arrow], active inflammation, and rupture [(B), asterisks] of the follicular epithelium with "floating" hair fragments [[(B), arrow]]Subsequently, a secondary inflammatory response is induced with an influx of numerous neutrophils [(C), arrows] and granulomatous foreign body reaction with giant cells [(C), asterisks].<ref>{{cite journal|last1=Giang|first1=Jenny|last2=Seelen|first2=Marc A. J.|last3=van Doorn|first3=Martijn B. A.|last4=Rissmann|first4=Robert|last5=Prens|first5=Errol P.|last6=Damman|first6=Jeffrey|title=Complement Activation in Inflammatory Skin Diseases|journal=Frontiers in Immunology|volume=9|year=2018|article-number=639|issn=1664-3224|doi=10.3389/fimmu.2018.00639|doi-access=free|pmid=29713318|pmc=5911619}}</ref>]]
Hidradenitis suppurativa presents itself in three stages.<ref name="dermnetnz">{{DermNet|acne/hidradenitis-suppurativa}}</ref><ref name="HSUSA">{{cite web|url=http://www.hs-usa.org/hidradenitis_suppurativa.htm |title=HS-USA:: What is Hidradenitis Suppurativa? |access-date=2013-07-20 |archive-url=https://web.archive.org/web/20130617013637/http://www.hs-usa.org/hidradenitis_suppurativa.htm |archive-date=17 June 2013 }}</ref> Due to the large spectrum of clinical severity and the severe impact on [[quality of life]], a reliable method for evaluating HS severity is needed.{{citation needed|date=September 2020}}

==== Hurley's staging system ====

Hurley's staging system was the first classification system proposed and is still in use for the classification of patients with skin diseases (i.e., [[psoriasis]], HS, [[acne]]). Hurley separated patients into three groups based largely on the presence and extent of [[Wound healing|cicatrization]] and [[Sinus (anatomy)|sinuses]]. It has been used as a basis for [[clinical trials]] in the past and to determine appropriate therapy for patients. These three stages are based on Hurley's staging system, which relies on the [[Subjectivity|subjective]] extent of the diseased tissue. Hurley's three stages of hidradenitis suppurativa are:<ref>Hurley HJ. Axillary hyperhidrosis, apocrine bromhidrosis, hidradenitis suppurativa, and familial benign pemphigus: surgical approach. In: Roenigk RK, Roenigk HH, editors. Dermatologic surgery. Marcel Dekker, New York, 1989, pp. 729–739.</ref>

{| class="wikitable"
|-
! Stage
! Characteristics
|-
| I
| Solitary or multiple isolated abscess formation without scarring or sinus tracts (A few minor sites with rare inflammation; may be mistaken for [[Acne vulgaris|acne]].)
|-
| II
| Recurrent abscesses, single or multiple widely separated [[lesions]], with sinus tract formation  (Frequent [[inflammation]] restricts movement and may require minor [[surgery]] such as [[incision and drainage]].)
|-
| III
| Diffuse or broad involvement across a regional area with multiple interconnected sinus tracts and abscesses  ([[Inflammation]] of sites to the size of golf balls, or sometimes baseballs; scarring develops, including [[Subcutaneous tissue|subcutaneous]] tracts of infection – see [[fistula]].  Obviously, patients at this stage may be unable to function.)
|}

==== Sartorius staging system ====

The Sartorius staging system is more sophisticated than Hurley's. Sartorius ''et al.'' suggested that the Hurley system is not sophisticated enough to assess treatment effects in clinical trials during research. This classification allows for better dynamic monitoring of the disease severity in individual patients. The elements of this staging system are:<ref>{{cite journal | vauthors = Sartorius K, Lapins J, Emtestam L, Jemec GB | title = Suggestions for uniform outcome variables when reporting treatment effects in hidradenitis suppurativa | journal = The British Journal of Dermatology | volume = 149 | issue = 1 | pages = 211–3 | date = July 2003 | pmid = 12890229 | doi = 10.1046/j.1365-2133.2003.05390.x | s2cid = 46142606 }}</ref>
* [[Anatomic]] regions involved (axilla, groin, gluteal, or other region or inframammary region left or right)
* Number and types of [[lesions]] involved (abscesses, [[Nodule (medicine)|nodules]], [[fistulas]] or sinuses, scars, points for lesions of all regions involved)
* The distance between lesions, in particular, the longest distance between two relevant lesions (i.e., nodules and fistulas in each region or size if only one lesion is present)
* The presence of normal skin in between lesions (i.e., if all lesions are separated by normal skin)

Points are accumulated in the above categories and added to give a regional and total score. In addition, the authors recommend adding a visual analog scale for pain or using the [[Dermatology Life Quality Index|dermatology life quality index]] (DLQI, or the 'skindex') when assessing HS.<ref>{{cite journal | vauthors = Wolkenstein P, Loundou A, Barrau K, Auquier P, Revuz J | title = Quality of life impairment in hidradenitis suppurativa: a study of 61 cases | journal = Journal of the American Academy of Dermatology | volume = 56 | issue = 4 | pages = 621–3 | date = April 2007 | pmid = 17097366 | doi = 10.1016/j.jaad.2006.08.061 | author6 = Quality of Life Group of the French Society of Dermatology }}</ref>

== Treatment ==
Treatment depends upon the presentation and severity of the disease. Due to the poorly studied nature of the disease, the effectiveness of medications and therapies was unclear.<ref>{{cite journal | vauthors = Ingram JR, Woo PN, Chua SL, Ormerod AD, Desai N, Kai AC, Hood K, Burton T, Kerdel F, Garner SE, Piguet V | title = Interventions for hidradenitis suppurativa: a Cochrane systematic review incorporating GRADE assessment of evidence quality | journal = The British Journal of Dermatology | volume = 174 | issue = 5 | pages = 970–8 | date = May 2016 | pmid = 26801356 | pmc = 5021164 | doi = 10.1111/bjd.14418 }}</ref> Clear and sensitive communication from health care professionals, and social and psychological interventions can help manage the emotional impact of the condition and aid necessary lifestyle changes.<ref name=":0" /><ref name=":1" /> In May 2023, the European Commission (EC) approved [[Secukinumab|Cosentyx (secukinumab)]] for active moderate to severe hidradenitis suppurativa in adults.<ref>{{Cite journal |last=Sharma |first=Ruchika |date=2023-06-01 |title=Novartis Cosentyx gets European Commission nod for use in adults with hidradenitis suppurativa |url=https://medicaldialogues.in/news/industry/pharma/novartis-cosentyx-gets-european-commission-nod-for-use-in-adults-with-hidradenitis-suppurativa-112302 |access-date=2023-06-01 |website=medicaldialogues.in |language=en}}</ref>

Other possible treatments include the following:

=== Cryotherapy ===
[[Cryotherapy]] has demonstrated efficacy against the disease, with 88% of persistent lesions resolving in a clinical trial of 23 patients.<ref>{{cite journal | vauthors = Dell'Antonia M, Anedda J, Tatti A, Falco A, Sanna S, Ferreli C, Atzori L | title = Non-surgical treatment of hidradenitis suppurativa: the role of cryotherapy | journal = Frontiers in Medicine | volume = 10 | doi = 10.3389/fmed.2023.1141691 | date = April 2023 | article-number = 1141691 | pmid = 37144039  | pmc = 10151524 | doi-access = free }}</ref>

=== Lifestyle ===
Warm baths may be tried in those with mild disease.<ref name="GARD2017" /> [[Weight loss]] and [[smoking cessation]] are recommended.<ref name="NEJM2012" /> 

=== Medication ===
* [[Antibiotics]]: taken by mouth, these are used for their anti-inflammatory properties rather than to treat infection. Most effective is a combination of [[rifampicin]] and [[clindamycin]] given concurrently for 2–3 months. Popular antibiotics also include [[tetracycline]] and [[minocycline]].<ref>{{cite journal | vauthors = Scheinfeld N | title = Hidradenitis suppurativa: A practical review of possible medical treatments based on over 350 hidradenitis patients | journal = Dermatology Online Journal | volume = 19 | issue = 4 | page = 1 | date = April 2013 | doi = 10.5070/D35VW402NF | pmid = 24021361 }}</ref> Topical clindamycin has been shown to have an effect in double-blind placebo-controlled studies.<ref>{{cite journal | vauthors = Clemmensen OJ | title = Topical treatment of hidradenitis suppurativa with clindamycin | journal = International Journal of Dermatology | volume = 22 | issue = 5 | pages = 325–8 | date = June 1983 | pmid = 6347922 | doi = 10.1111/j.1365-4362.1983.tb02150.x | s2cid = 46661288 }}</ref> In a retrospective review and telephone survey, intravenous ertapenem therapy showed clinical improvement with 80.3% of subjects reporting medium to high satisfaction and 90.8% would recommend ertapenem to other patients.<ref>{{cite journal |vauthors=Nosrati A, Ch'en PY, Torpey ME, Shokrian N, Ball G, Benesh G, Andriano TM, Zhu TR, Heibel HD, Hosgood HD, Campton KL, Cohen SR |display-authors=5 |title=Efficacy and Durability of Intravenous Ertapenem Therapy for Recalcitrant Hidradenitis Suppurativa |journal=JAMA Dermatology |date=14 February 2024 <!--e236201--> |volume=160 |issue=3 |pages=312–318 |doi=10.1001/jamadermatol.2023.6201 |pmid=38353987 |pmc=10867774}}</ref>
* [[Corticosteroid]] injections, also known as intralesional steroids, can be useful for localized disease if the drug can be prevented from escaping via the sinuses.
* [[Antiandrogen]] therapy, hormonal therapy with antiandrogenic medications such as [[spironolactone]], [[flutamide]], [[cyproterone acetate]], [[ethinylestradiol]], [[finasteride]], [[dutasteride]], and [[metformin]], are effective in clinical studies.<ref name="NikolakisKyrgidis2019">{{cite journal|last1=Nikolakis|first1=Georgios|last2=Kyrgidis|first2=Athanassios|last3=Zouboulis|first3=Christos C.|title=Is There a Role for Antiandrogen Therapy for Hidradenitis Suppurativa? A Systematic Review of Published Data|journal=American Journal of Clinical Dermatology|volume=20|issue=4|year=2019|pages=503–513|issn=1175-0561|doi=10.1007/s40257-019-00442-w|pmid=31073704|s2cid=149443722}}</ref><ref name="GoldburgStrober2019">{{cite journal|last1=Goldburg|first1=Samantha R.|last2=Strober|first2=Bruce E.|last3=Payette|first3=Michael J.|title=Part 2. Current and emerging treatments for hidradenitis suppurativa|journal=Journal of the American Academy of Dermatology|year=2019|volume=82|issue=5|pages=1061–1082|issn=0190-9622|doi=10.1016/j.jaad.2019.08.089|pmid=31604100|s2cid=204331143}}</ref><ref name="StudentHejmo2019">{{cite journal|last1=Student|first1=Sebastian|last2=Hejmo|first2=Tomasz|last3=Poterała-Hejmo|first3=Aleksandra|last4=Leśniak|first4=Aleksandra|last5=Bułdak|first5=Rafał|title=Anti-androgen hormonal therapy for cancer and other diseases|journal=European Journal of Pharmacology|volume=866|year=2020|article-number=172783|issn=0014-2999|doi=10.1016/j.ejphar.2019.172783|pmid=31712062|doi-access=free}}</ref> However, the [[quality of evidence|quality of available evidence]] is low and does not presently allow for robust evidence-based recommendations.<ref name="NikolakisKyrgidis2019" /><ref name="GoldburgStrober2019" />
* [[Intravenous therapy|Intravenous]] infusion or subcutaneous injection of anti-inflammatory ([[TNF inhibitor]]s; anti-[[TNF-alpha]]) drugs such as [[infliximab]], and [[etanercept]]<ref>{{cite journal | vauthors = Cusack C, Buckley C | title = Etanercept: effective in the management of hidradenitis suppurativa | journal = The British Journal of Dermatology | volume = 154 | issue = 4 | pages = 726–729 | date = April 2006 | pmid = 16536817 | doi = 10.1111/j.1365-2133.2005.07067.x | s2cid = 23743987 }}</ref> This use of these drugs is not currently approved in the United States by the [[Food and Drug Administration]] (FDA) and is somewhat controversial.{{cn|date=August 2025}}
* [[Biologics]]: Various biologics can improve HS lesions.<ref>{{cite journal | vauthors = Haslund P, Lee RA, Jemec GB | title = Treatment of hidradenitis suppurativa with tumour necrosis factor-alpha inhibitors | journal = Acta Dermato-Venereologica | volume = 89 | issue = 6 | pages = 595–600 | date = November 2009 | pmid = 19997689 | doi = 10.2340/00015555-0747 | doi-access = free }}</ref> Specifically [[adalimumab]] at weekly intervals is useful.<ref>{{cite journal | vauthors = Ingram JR | title = Interventions for Hidradenitis Suppurativa: Updated Summary of an Original Cochrane Review | journal = JAMA Dermatology | volume = 153 | issue = 5 | pages = 458–459 | date = May 2017 | pmid = 28355440 | doi = 10.1001/jamadermatol.2017.0432 }}</ref> Adalimumab and secukinumab<ref>{{cite press release | url=https://www.novartis.com/us-en/news/media-releases/fda-approves-novartis-cosentyx-first-new-biologic-treatment-option-hidradenitis-suppurativa-patients-nearly-decade | title=FDA approves Novartis Cosentyx® as the first new biologic treatment option for hidradenitis suppurativa patients in nearly a decade |publisher=Novartis |date=October 31, 2023 |access-date=7 August 2025}}</ref><ref>{{cite web | url=https://www.cosentyx.com/hidradenitis-suppurativa/signs-and-symptoms | title=What is hidradenitis suppurativa (HS)? |website=Cosentyx (secukinumab) |publisher=Novartis |access-date=7 August 2025}}</ref> are both approved by the FDA for the treatment of HS as of 2023.
* Topical [[isotretinoin]] is usually ineffective in people with HS, and is more commonly known as a medication for the treatment of [[acne vulgaris]]. Individuals affected by HS who responded to isotretinoin treatment tended to have milder cases of the condition.<ref>{{cite journal | vauthors = Nickle SB, Peterson N, Peterson M | title = Updated Physician's Guide to the Off-label Uses of Oral Isotretinoin | journal = The Journal of Clinical and Aesthetic Dermatology | volume = 7 | issue = 4 | pages = 22–34 | date = April 2014 | pmid = 24765227 | pmc = 3990537 }}</ref>
* [[Zinc]] and [[nicotinamide]], at doses of 90&nbsp;mg and 30&nbsp;mg respectively, have shown efficacy against mild to moderate hidradenitis suppurativa in a controlled retrospective clinical trial.<ref>{{cite journal | vauthors = Molinelli E, Brisigotti V, Campanati A, Sapigni C, Giacchetti A, Cota C, Offidani A | title = Efficacy of oral zinc and nicotinamide as maintenance therapy for mild/moderate hidradenitis suppurativa: A controlled retrospective clinical study | journal = Journal of the American Academy of Dermatology | volume = 83 | issue = 2 | pages = 665–667 | date = August 2020 | doi = 10.1016/j.jaad.2020.04.092 | pmid = 32339699 | doi-access = free }}</ref>

=== Surgery ===

When the process becomes chronic, wide surgical excision is the procedure of choice.

Wounds in the affected area do not heal by [[secondary intention]], and immediate or delayed application of a split-thickness [[skin graft]] is an option.<ref name="Schawartzprinciples" />
Another option is covering the defect with a [[Perforator flaps|perforator flap]]. With this technique, the (mostly totally excised) defect is covered with tissue from an area nearby. For example, the axilla with a fully excised defect of 15 × 7&nbsp;cm can be covered with a thoracodorsal artery perforator flap.{{citation needed|date=September 2020}}. A less invasive excision procedure called Skin-Tissue-sparing Excision with [[Electrosurgical]] Peeling or "STEEP" has also been developed for treating moderate to severe disease.<ref>{{cite journal | vauthors = Blok J, Spoo J, Leeman F, Jonkman M, Horváth B | title = Skin-Tissue-sparing Excision with Electrosurgical Peeling (STEEP): a surgical treatment option for severe hidradenitis suppurativa Hurley stage II/III | journal = Journal of the European Academy of Dermatology and Venereology | volume = 29 | issue = 2 | pages = 379–382 | date = February 2015 | doi = 10.1111/jdv.12376 | pmid = 24460855 | s2cid = 21974148 }}</ref>

=== Laser hair removal ===
{{further|Laser ablation#Medicine}}
The 1064&nbsp;[[nanometer|nm]] [[wavelength]] ([[near-infrared]]) laser for hair removal may aid in the treatment of HS.<ref>{{cite journal | vauthors = Scheinfeld N | title = Hidradenitis suppurativa: A practical review of possible medical treatments based on over 350 hidradenitis patients | journal = Dermatology Online Journal | volume = 19 | issue = 4 | page = 1 | date = April 2013 | doi = 10.5070/D35VW402NF | pmid = 24021361 | url = http://escholarship.org/uc/item/5vw402nf | access-date = 4 March 2014 | url-status = live | archive-url = https://web.archive.org/web/20140306231203/http://escholarship.org/uc/item/5vw402nf | archive-date = 6 March 2014 | url-access = subscription }}</ref> A randomized control study has shown improvement in HS lesions with the use of a [[Nd:YAG laser]].<ref>{{cite journal | vauthors = Xu LY, Wright DR, Mahmoud BH, Ozog DM, Mehregan DA, Hamzavi IH | title = Histopathologic study of hidradenitis suppurativa following long-pulsed 1064-nm Nd:YAG laser treatment | journal = Archives of Dermatology | volume = 147 | issue = 1 | pages = 21–8 | date = January 2011 | pmid = 20855672 | doi = 10.1001/archdermatol.2010.245 | doi-access = free }}</ref>

=== Botox injection ===
A 2022 study reported that administration of [[Botulinum toxin]] resulted in either clinical improvement or improved quality of life in 96.8% (n = 30/31) of HS patients. The level of evidence was moderate. It concluded that the treatment was a safe and potentially effective alternative for hidradenitis suppurativa patients resistant to standard-of-care therapies.<ref>{{cite journal | pmid=35389587 | date=2022 | title=Botulinum Toxin in Hidradenitis Suppurativa: A Systematic Review | journal=Journal of Drugs in Dermatology | volume=21 | issue=4 | pages=408–412 | vauthors = Ravi M, Trinidad J }}</ref>

== Prognosis ==
[[File:HS lesions.jpg|thumb|Hidradenitis suppurativa stage III. Open lesions are extremely painful.]]
[[File:HS on leg.jpg|thumb|Hidradenitis suppurativa stage III. Inflamed lesion.]]
In stage III disease, as classified by Hurley's staging system, fistulae left undiscovered, undiagnosed, or untreated can rarely lead to the development of [[squamous cell carcinoma]] in the [[anus]] or other affected areas.<ref>{{cite journal | vauthors = Talmant JC, Bruant-Rodier C, Nunziata AC, Rodier JF, Wilk A | title = Dégénérescence de maladie de Verneuil en carcinome épidermoïde: à propos de 2 cas et revue de la littérature | trans-title = Squamous cell carcinoma arising in Verneuil's disease: two cases and literature review<!--translation given by journal itself--> | language = fr | journal = Annales de Chirurgie Plastique et Esthétique | volume = 51 | issue = 1 | pages = 82–86 | date = February 2006 | pmid = 16488526 | doi = 10.1016/j.anplas.2005.11.002 }}</ref><ref>{{cite journal | vauthors = Short KA, Kalu G, Mortimer PS, Higgins EM | title = Vulval squamous cell carcinoma arising in chronic hidradenitis suppurativa | journal = Clinical and Experimental Dermatology | volume = 30 | issue = 5 | pages = 481–483 | date = September 2005 | pmid = 16045671 | doi = 10.1111/j.1365-2230.2005.01875.x | s2cid = 33438993 }}</ref> Other stage III chronic sequelae may also include [[anemia]], multi-localized [[infections]], [[amyloidosis]], and [[arthropathy]]. Stage III complications have been known to lead to [[sepsis]], but clinical data are still uncertain.

=== Comorbidities and complications ===
[[Endocrine disease]]s are more common in people who have HS.<ref name="AbuRached2022">{{cite journal |last1=Abu Rached |first1=N. |last2=Gambichler |first2=T. |last3=Dietrich |first3=J. W. |last4=Ocker |first4=L. |last5=Seifert |first5=C. |last6=Stockfleth |first6=E. |last7=Bechara |first7=F. G. |title=The Role of Hormones in Hidradenitis Suppurativa: A Systematic Review |journal=International Journal of Molecular Sciences |date=3 December 2022 |volume=23 |issue=23 |article-number=15250 |doi=10.3390/ijms232315250 |doi-access=free |pmid=36499573|pmc=9736970 }}</ref> [[Diabetes mellitus]] may be both a causal factor contributing to the evolution and/or severity of HS and a consequence of inflammation in HS.<ref name="AbuRached2023" /><ref name="AbuRached2024"/> [[Thyroid disease|Thyroid disorders]] are also more common in patients with HS.<ref name="AbuRached2023b">{{cite journal |last1=Abu Rached |first1=N. |last2=Dietrich |first2=J. W. |last3=Ocker |first3=L. |last4=Quast |first4=D. R. |last5=Scheel |first5=C. |last6=Gambichler |first6=T. |last7=Bechara |first7=F. G. |title=Primary Thyroid Dysfunction Is Prevalent in Hidradenitis Suppurativa and Marked by a Signature of Hypothyroid Graves' Disease: A Case-Control Study |journal=Journal of Clinical Medicine |date=4 December 2023 |volume=12 |issue=23 |page=7490 |doi=10.3390/jcm12237490 |doi-access=free |pmid=38068542|pmc=10707714 }}</ref>

* [[Contractures]] and reduced mobility of the lower limbs and [[axillae]] due to [[fibrosis]] and scarring occur. Severe [[lymphedema]] may develop in the lower limbs.
* Local and systemic [[infections]] ([[meningitis]], [[bronchitis]], [[pneumonia]], etc.), are seen, which may even progress to [[sepsis]].
* Higher risk for [[diabetes mellitus]], [[hypertension|high blood pressure]], [[myocardial infarction|heart attacks]], and [[metabolic syndrome]].<ref name="AbuRached2023" /> Persons affected by HS have reduced [[insulin sensitivity]] ([[SPINA-GR]]), which, if uncompensated by increased [[pancreatic beta cell function]], can result in [[prediabetes]] and overt diabetes mellitus.<ref name="AbuRached_2025">{{cite journal |last1=Abu Rached |first1=Nessr |last2=Dietrich |first2=Johannes W. |last3=Ocker |first3=Lennart |last4=Stockfleth |first4=Eggert |last5=Haven |first5=Yannik |last6=Myszkowski |first6=Daniel |last7=Bechara |first7=Falk G. |title=Endotyping Insulin–Glucose Homeostasis in Hidradenitis Suppurativa: The Impact of Diabetes Mellitus and Inflammation |journal=Journal of Clinical Medicine |date=21 March 2025 |volume=14 |issue=7 |page=2145 |pmid=40217596 |doi=10.3390/jcm14072145|doi-access=free |pmc=11990022 }}</ref> Treatment of HS may contribute to remission of diabetes.<ref name="AbuRached2024">{{cite journal |last1=Abu Rached |first1=N. |last2=Dietrich |first2=J. W. |last3=Ocker |first3=L. |last4=Quast |first4=D. R. |last5=Stockfleth |first5=E. |last6=Bechara |first6=F. G. |title=Diabetes remission associated with optimized treatment of hidradenitis suppurativa |journal=Journal der Deutschen Dermatologischen Gesellschaft |trans-journal=Journal of the German Society of Dermatology |date=6 August 2024 |volume=22 |issue=10 |pages=1427–1429 |doi=10.1111/ddg.15490 |pmid=39106221|doi-access=free }}</ref>
* HS is associated with an increased risk of [[polycystic ovarian syndrome]].<ref name="PhanPCOS">{{cite journal |last1=Phan |first1=K. |last2=Charlton |first2=O. |last3=Smith |first3=S. D. |title=Hidradenitis suppurativa and polycystic ovarian syndrome: Systematic review and meta-analysis |journal=The Australasian Journal of Dermatology |date=February 2020 |volume=61 |issue=1 |pages=e28–33 |doi=10.1111/ajd.13110 |pmid=31261440 }}</ref><ref name="SuppurativeFoundationGuidelines">{{cite journal |last1=Garg |first1=A. |last2=Malviya |first2=N. |last3=Strunk |first3=A. |last4=Wright |first4=S. |last5=Alavi |first5=A. |last6=Alhusayen |first6=R. |last7=Alikhan |first7=A. |last8=Daveluy |first8=S. D. |last9=Delorme |first9=I. |last10=Goldfarb |first10=N. |last11=Gulliver |first11=W. |last12=Hamzavi |first12=I. |last13=Jaleel |first13=T. |last14=Kimbell |first14=A. B. |last15=Kirby |first15=J. S. |last16=Kirchhof |first16=M. G. |last17=Lester |first17=J. |last18=Lev-Tov |first18=H. |last19=Lowes |first19=M. A. |last20=Micheletti |first20=R. |last21=Orenstein |first21=L. A. |last22=Piguet |first22=V. |last23=Sayed |first23=C. |last24=Tan |first24=J. |last25=Naik |first25=H. B. |display-authors=6 |title=Comorbidity screening in hidradenitis suppurativa: Evidence-based recommendations from the US and Canadian Hidradenitis Suppurativa Foundations |journal=Journal of the American Academy of Dermatology |date=May 2022 |volume=86 |issue=5 |pages=1092–1101 |doi=10.1016/j.jaad.2021.01.059 |pmid=33493574 |pmc=8298595 |url=https://www.jaad.org/article/S0190-9622(21)00213-9/fulltext |access-date=10 April 2025}}</ref> 
* [[Interstitial keratitis]]
* [[Pyoderma gangrenosum]]<ref name="SuppurativeFoundationGuidelines"/>
* [[Pilonidal disease]]<ref name="SuppurativeFoundationGuidelines"/>
* [[Dyslipidemia]]<ref name="SuppurativeFoundationGuidelines"/>
* Anal, rectal, or urethral [[fistulae]]<ref>{{cite book |last=Hurley |first=H. J. J. |title=Apocrine glands |location=New York |publisher=McGraw Hill |year=1979}}</ref>{{isbn?|date=August 2025}}
* Normochromic or hypochromic [[anemia]]<ref>{{cite journal|vauthors=Tennant F, Bergeron JR, Stone OJ, Mullins JF|title=Anemia associated with hidradenitis suppurativa|journal=Archives of Dermatology|volume=98|issue=2|pages=138–40|date=August 1968|pmid=5667225|doi= 10.1001/archderm.98.2.138 }}</ref>
* People with HS may be at increased risk for autoimmune disorders, including [[ankylosing spondylitis]], [[rheumatoid arthritis]], [[psoriatic arthritis]], and [[inflammatory bowel disease]]s, such as [[Crohn's disease]].<ref name="SuppurativeFoundationGuidelines"/><ref>{{cite journal|vauthors=Schneeweiss MC, Kim SC, Schneeweiss S, Rosmarin D, Merola JF|title=Risk of inflammatory arthritis after a new diagnosis of hidradenitis suppurativa|journal=JAMA Dermatology|doi= 10.1001/jamadermatol.2019.4590|doi-access=free|volume=156|year=2020|issue=3|pages=342–345|pmid=31968066|pmc=6990727}}</ref>
* [[Squamous cell carcinoma]] has been found on rare occasions in chronic hidradenitis suppurativa of the anogenital region.<ref>{{cite journal | vauthors = Williams ST, Busby RC, DeMuth RJ, Nelson H | title = Perineal hidradenitis suppurativa: presentation of two unusual complications and a review | journal = Annals of Plastic Surgery | volume = 26 | issue = 5 | pages = 456–462 | date = May 1991 | pmid = 1952719 | doi = 10.1097/00000637-199105000-00008 }}</ref> The mean time to the onset of this type of lesion is 10 years or more and the [[tumors]] are usually highly aggressive.
* Tumors of the [[lung]] and [[oral cavity]], and [[liver cancer]]<ref>{{cite journal | vauthors = Lapins J, Ye W, Nyrén O, Emtestam L | title = Incidence of cancer among patients with hidradenitis suppurativa | journal = Archives of Dermatology | volume = 137 | issue = 6 | pages = 730–734 | date = June 2001 | pmid = 11405761 }}</ref>
* [[Hypoproteinemia]] and [[amyloidosis]], which can lead to [[kidney failure]] and [[death]]<ref>{{cite journal | vauthors = Moschella SL | title = Hidradenitis suppurativa. Complications resulting in death | journal = JAMA | volume = 198 | issue = 1 | pages = 201–203 | date = October 1966 | pmid = 5953172 | doi = 10.1001/jama.198.1.201 }}</ref>
* Seronegative and usually asymmetric [[arthropathy]]: pauciarticular [[arthritis]], [[polyarthritis]]/[[polyarthralgia]] syndrome.<ref>{{cite journal | vauthors = Vasey FB, Fenske NA, Clement GB, Bridgeford PH, Germain BF, Espinoza LR | title = Immunological studies of the arthritis of acne conglobata and hidradenitis suppurativa | journal = Clinical and Experimental Rheumatology | volume = 2 | issue = 4 | pages = 309–311 | year = 1984 | pmid = 6241861 }}</ref>

=== Impact on mental health ===
HS is a painful and socially isolating condition that leads to a negative impact on mental health as well. A 2020 meta-analysis found that 21% of people with HS have [[Depression (mood)|depression]], including [[major depressive disorder|major depression]] and 12% have [[Anxiety disorder|anxiety]], including [[generalized anxiety disorder]] and a higher risk of [[suicide]].<ref name="SuppurativeFoundationGuidelines"/><ref>{{Cite journal |last1=Jalenques |first1=Isabelle |last2=Ciortianu |first2=Laura |last3=Pereira |first3=Bruno |last4=D'Incan |first4=Michel |last5=Lauron |first5=Sophie |last6=Rondepierre |first6=Fabien |date=25 March 2020 |title=The prevalence and odds of anxiety and depression in children and adults with hidradenitis suppurativa: Systematic review and meta-analysis |journal=Journal of the American Academy of Dermatology |language=en |volume=83 |issue=2 |pages=542–553 |doi=10.1016/j.jaad.2020.03.041|pmid=32222447 |s2cid=214716227 |doi-access=free }}</ref> A 2020 study found that people with HS have [[suicide]] rates more than double the rates in controls, and also have a higher risk of attempting suicide.<ref name=":2">{{Cite journal |last=Ingram |first=John R. |date=3 September 2020 |title=The epidemiology of hidradenitis suppurativa |journal=British Journal of Dermatology |language=en |volume=183 |issue=6 |pages=990–998 |doi=10.1111/bjd.19435 |pmid=32880911 |s2cid=221475227 |issn=0007-0963|doi-access=free }}</ref>

== Epidemiology ==

=== Prevalence ===
Estimates of the prevalence of HS vary worldwide, and there is no accepted generalization. In the US, the prevalence is estimated to be 0.1% while in Europe it is thought to be 1% or more.<ref name=":2" />

==== Sex ====
In North America and Europe, women are three times more likely to have HS. However, in South Korea, men are twice as likely to have HS.<ref name=":2" />

==== Age ====
HS is the most prevalent in people in their 40s and 50s.<ref name=":2" />

== History ==
* From 1833 to 1839, in a series of three publications, Velpeau identified and described a disease now known as hidradenitis suppurativa.<ref>{{cite dictionary |last=Velpeau |first=A. |title=Aisselle |trans-title=Armpit |location=Paris |publisher=Bechet Jeune |dictionary=Dictionnaire de médecine, ou Répertoire générale des sciences médicales considérées sous le rapport théorique et pratique |language=fr <!--Parameter doesn't exist: |trans-dictionary=Dictionary of medicine, or General repertory of the medical sciences considered from the theoretical and practical perspective--> |year=1839 <!--This is from the 1833 edition of the dictionary, possibly relevant: |url=https://archive.org/details/BIUSante_34820x02/page/86 |volume=2 |page=86-->}}</ref>
* In 1854, [[Aristide Auguste Stanislas Verneuil|Aristide Verneuil]] described hidradenitis suppurativa as {{lang|fr|hidrosadénite phlegmoneuse}} ("phlegmonous hidrosadenitis<!--sic-->"). This is how HS obtained the name "Verneuil's disease".<ref>{{cite journal |last=Verneuil |first=A. S. |title=Études sur les tumeurs de la peau et quelques maladies de glandes sudoripares |trans-title=Studies on skin tumors; some diseases of the sweat glands |language=fr |journal=Archives of General Medicine |year=1854 |volume=94 |pages=693–705}}</ref>
* In 1922, Paul Schiefferdecker hypothesized a [[pathogenic]] link between "acne inversa" and human sweat glands.<ref>{{cite book | vauthors = Schiefferdecker P |title=Die Hautdrüsen der Menschen und der Säugetiere, ihre bioologische und rassenanatomische Bedeutung sowie die Muscularis sexualis |trans-title=The skin glands of humans and mammals, their bioological and anatomical racial meaning and sexual muscle |series=Zoologica |volume=72 |publisher=E. Schweizerbart |location=Stuttgart |year=1922}}{{page needed|date=August 2015}}</ref>
* In 1956, Pillsbury ''et al''.<ref>{{cite book |vauthors=Pillsbury DM, Shelley WB, Kligmann AM |chapter=Bacterial infections of the skin |veditors=Pillsbury DM |title=Dermatoloy |edition=1st |location=Philadelphia |year=1956 |pages=482–489}}</ref> coined the term ''[[Cellulitis#Differential diagnosis|follicular occlusion triad]]'' for the common association of hidradenitis suppurativa, [[acne conglobata]] and [[dissecting cellulitis of the scalp]]. Modern clinical research still employs Pillsbury's terminology for these conditions' descriptions.<ref>{{cite journal |title=Triads in Dermatology |first1=Prachi G. |last1=Agrawal |first2=Uday S. |last2=Khopkar |first3=Sunanda A. |last3=Mahajan |first4=Sunil N. |last4=Mishra |journal=Indian Journal of Dermatology |date=September–October 2013 |volume=58 |issue=5 |pages=346–351 |doi=10.4103/0019-5154.117297 |doi-access=free |pmid=24082177 |pmc=3778772 }}</ref>
* In 1975, Plewig and Kligman, following Pillsbury's research path, modified the "acne triad", replacing it with the "acne tetrad: acne triad, plus [[pilonidal sinus]]".<ref>{{cite book |last1=Plewig |first1=Gerd |last2=Kligman |first2=Albert M. |title=Acne |chapter=Acne Conglobata |year=1975 |pages=168–203 |editor1-first=Gerd |editor1-last=Plewig |editor2-first=Albert M. |editor2-last=Kligman |isbn=978-3-642-96246-2 |doi=10.1007/978-3-642-96246-2_11 }}</ref> Plewig and Kligman's research follows in Pillsbury's footsteps, offering explanations of the symptoms associated with hidradenitis suppurativa.
* In 1989, Plewig and Steger's research led them to rename hidradenitis suppurativa, calling it "acne inversa" – which is not still used today in [[medical terminology]], although some individuals still use this outdated term.<ref name="ReferenceA">{{cite book |vauthors=Plewig G, Steger M |chapter=Acne inversa (alias acne triad, acne tetrad or hidradenitis suppurativa) |veditors=Marks R, Plewig G |title=Acne and Related Disorders |location=London |publisher=Martin Dunitz |year=1989 |pages=345–357}}</ref>

A surgeon from Paris, Velpeau, described an unusual inflammatory process with the formation of superficial [[axilla]]ry, sub[[mammary]], and [[perianal]] abscesses, in a series of three publications from 1833 to 1839. One of his colleagues, also located in Paris, named Verneuil, coined the term {{lang|fr|hidrosadénite phlegmoneuse}} about 15 years later. This name for the disease reflects the former [[pathogenetic]] model of acne inversa, which considered inflammation of sweat glands as the primary cause of hidradenitis suppurativa. In 1922, Paul Schiefferdecker suspected a pathogenic association between acne inversa and apocrine sweat glands. In 1956, Pillsbury postulated follicular occlusion as the cause of acne inversa, which they grouped together with acne conglobata and {{lang|la|perifolliculitis capitis abscendens et suffodiens}} ("dissecting cellulitis of the scalp") as the "acne triad". Plewig and Kligman added another element to their acne triad, [[pilonidal sinus]]. Plewig ''et al.'' noted that this new "acne tetrad" includes all the elements found in the original "acne triad", in addition to a fourth element, pilonidal sinus. In 1989, Plewig and Steger introduced the term "acne inversa", indicating a follicular source of the disease and replacing older terms such as "Verneuil disease".

{| class="wikitable"
|-
! Author !! Year !! Findings
|-
| Velpeau || 1839 || First description of hidradenitis suppurativa
|-
| Verneuil || 1854 || {{lang|fr|"Hidrosadénite phlegmoneuse"}}
|-
| Pillsbury || 1956 || Acne triad ({{lang|la|hidradenitis suppurativa}}, {{lang|la|perifolliculitis capitis abscendens et suffodiens}}, {{lang|la|acne congoblata}})
|-
| Plewig & Kligman || 1975 || Acne tetrad (acne triad + pilonidal sinus)
|-
| Plewig & Steger || 1989 || Acne inversa
|}

=== Other names ===

Hidradenitis suppurativa has been referred to by multiple names in the literature and various cultures. Some of these are also used to describe different diseases or specific instances of this disease.<ref name="HSUSA" />

* Acne conglobata – not really a [[synonym]] – this is a similar process but in classic acne areas of the chest and back
* Acne inversa – a proposed new term<ref>{{cite journal | vauthors = Sellheyer K, Krahl D | title='Hidradenitis suppurativa' is acne inversa! An appeal to (finally) abandon a misnomer | journal = International Journal of Dermatology | volume = 44 | issue = 7 | pages = 535–540 | date = July 2005 | pmid = 15985019 | doi = 10.1111/j.1365-4632.2004.02536.x | s2cid = 34144101 }}</ref><ref name="pmid17343599">{{cite journal | vauthors = Bazex J, Bayle P, San B | title = Hidradenitis suppurativa is acne inversa | journal = International Journal of Dermatology | volume = 46 | issue = 3 | pages = 330<!--This is a different article. Cite it separately: author reply 330–302--> | date = March 2007 | pmid = 17343599 | doi = 10.1111/j.1365-4632.2007.02872.x | s2cid = 43108078 }}</ref> which has not gained widespread favor.<ref>{{cite journal | vauthors = Scheinfeld N | title = Hidradenitis should not be renamed acne inversa | journal = Dermatology Online Journal | volume = 12 | issue = 7 | page = 6 | date = December 2006 | doi = 10.5070/D35G21T4MQ | pmid = 17459292 }}</ref>
* Apocrine acne – an outdated term based on the disproven{{Citation needed|date=November 2019}} concept that apocrine glands are primarily involved, though many do have apocrine gland infection
* Apocrinitis – another outdated term based on the same thesis
* Fox-den disease – a term not used in medical literature, based on the deep [[fox]] den–like sinuses
* Hidradenitis supportiva – a misspelling
* Pyodermia fistulans significa – now considered archaic
* Verneuil's disease – recognizing the surgeon whose name is most often associated with the disorder as a result of his 1854–1865 studies<ref>{{Cite journal|author=Verneuil AS |title=Études sur les tumor de la peau |journal=Archives générales de médecine |volume=94 |page=693 |year=1854|language=fr}}</ref>

=== Histology ===

{| class="wikitable"
|-
! Author !! Year !! Major features
|-
| Plewig & Steger<ref name="ReferenceA" /> || 1989 || Initial [[hyperkeratosis]] of the [[Hair follicle|follicular]] infundibulum. [[Bacterial]] super-[[infection]] and follicle rupture. Granulomatous inflammatory reaction of the connective tissue. [[Apocrine]] and [[eccrine]] sweat glands secondarily involved.
|-
| Yu & Cook<ref>{{cite journal | vauthors = Yu CC, Cook MG | title = Hidradenitis suppurativa: a disease of follicular epithelium, rather than apocrine glands | journal = The British Journal of Dermatology | volume = 122 | issue = 6 | pages = 763–769 | date = June 1990 | pmid = 2369556 | doi = 10.1111/j.1365-2133.1990.tb06264.x | s2cid = 8857181 }}</ref> || 1990 || [[Cysts]] and sinus tracts lined with [[epithelium]], in part with [[hair]] shafts. [[Inflammation]] of [[apocrine]] sweat glands only if [[eccrine]] sweat glands and [[hair follicles]] are also inflamed.
|-
| Boer & Weltevreden<ref name="pmid8977671">{{cite journal | vauthors = Boer J, Weltevreden EF | title = Hidradenitis suppurativa or acne inversa. A clinicopathological study of early lesions | journal = The British Journal of Dermatology | volume = 135 | issue = 5 | pages = 721–725 | date = November 1996 | pmid = 8977671 | doi = 10.1111/j.1365-2133.1996.tb03880.x | doi-broken-date = 17 July 2025 }}</ref> || 1996 || Primary [[inflammation]] of the follicular infundibulum. [[Apocrine]] sweat glands are secondarily involved.
|}

== Society and culture ==

=== Experiences of people with HS ===
HS can have a strong negative impact on people's lives, as well as physical and mental health. People with HS often feel [[Social stigma|stigmatized]] and embarrassed by their condition. Many try to hide the symptoms, which can lead to impaired relationships and social isolation. A multidisciplinary approach by healthcare professionals, social support networks, and psychological interventions can contribute to a better [[Quality of life (healthcare)|quality of life]].<ref name=":0" /><ref name=":1" />
Compared to other skin diseases, HS has one of the highest [[Dermatology Life Quality Index]] (DLQI) scores.<ref>{{cite journal |last1=van Straalen |first1=KR |last2=Prens |first2=EP |last3=Gudjonsson |first3=JE |title=Insights into hidradenitis suppurativa |journal=The Journal of Allergy and Clinical Immunology |date=April 2022 |volume=149 |issue=4 |pages=1150–1161 |doi=10.1016/j.jaci.2022.02.003 |pmid=35189127|s2cid=247006893 }}</ref>

== References ==
{{Reflist}}

== External links ==
* [https://www.aad.org/public/diseases/a-z/hidradenitis-suppurativa-overview Hidradenitis suppurativa] at American Academy of Dermatology Association
* [https://www.bad.org.uk/pils/hidradenitis-suppurativa/ Hidradenitis suppurativa] at British Association of Dermatologists
* [https://www.hs-foundation.org/ Hidradenitis Suppurativa Foundation]
{{Medical resources
|  DiseasesDB     = 5892
|  ICD10          = {{ICD10|L|73|2|l|60}}
|  ICD9           = {{ICD9|705.83}}
|  ICDO           =
|  OMIM           =
|  MedlinePlus    =
|  eMedicineSubj  = emerg
|  eMedicineTopic = 259
|  eMedicine_mult = {{eMedicine2|med|2717}} {{eMedicine2|derm|892}}
|  MeshID         = D017497
}}
{{Disorders of skin appendages}}

{{Use dmy dates|date=August 2019}}

[[Category:Acneiform eruptions]]
[[Category:Inflammations]]
[[Category:Rare diseases]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Scarring]]