Hidradenitis Suppurativa

Pt with h/o smoking, metabolic syndrome, poor hygiene presents with solitary inflamed nodules in intertriginous region. Previous complications have included abscesses and formation of sinus tracts. Inflamed skin nodules tender to palpation surrounded by open comedones and scarring.

• Treatment per Hurley classification

  • Hurley I (mild disease): Start topical clindamycin; intralesional steroids/oral antibiotics for flares

  • Hurley II (nodules, sinus tracts, scaring present): Start doxycycline

  • Hurley III (extensive sinus tracts)

    • Start acitretin (oral retinoids) and consider adalimumab (Humira) therapy

    • Refer to dermatology

    • Schedule for definitive treatment with wide surgical excision

• Acutely inflamed nodule/sinus tract: Perform punch debridement for small nodules, unroofing for larger tracts

• Chronic/extensive disease: Refer pt for wide excision of lesions

• Patient counseled to stop smoking and lose weight to decrease disease severity and improve treatment response

Notes

• Conditions sometimes associated with hidradenitis: Arthritis, Crohn disease, DM, metabolic syndrome, PCOS, pyoderma gangrenosum, Trisomy 21

• Surgical treatment options include punch debridement, unroofing, skin sparing excision with electrosurgical peeling, and wide excision