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Hidradenitis suppurativa
Lesions may appear in the axillae, under the breasts, in the groin and about the buttock. This florid eruption under the breasts is more extensive than most cases.
Groin lesions are frequently misdiagnosed as boils. Look for the double comedones, as seen here in the left groin, to support the diagnosis.
Early hidradenitis presents as recurrent boils. These lesions smolder and recur to produce communicating sinus tracts as the disease pursues a relentless course.
Boil-like lesions occur in the axilla. Their numbers vary greatly. This is a particularly extensive eruption that has been relentless.
DESCRIPTION
A chronic disease that resembles boils. Forms sinus tracts and heals with scarring. Occurs in the axillae, anogenital regions, under the breasts. A disease of follicles, not apocrine glands.
HISTORY
• More common in females. • Appears after puberty. Most cases in second and third decade • Suspect hidradenitis when women complain of ‘boils in the groin’. • Worse in the obese. • Progressive and relentless. • Great variation in severity. • Most patients have a few boil-like lesions.
PHYSICAL FINDINGS
• Double or triple comedone is hallmark of disease; may be first sign of disease. • Boil-like lesions smolder and communicate to form sinus tracts that disrupt the dermis and heal with haphazard cord-like bands of scar tissue.
TREATMENT
• Incise and drain fluctuant cysts. • Intralesional triamcinolone acetonide (Kenalog) 2.5–10 mg/mL controls small cysts. • Tetracycline 250 or 500 mg b.i.d. Doxycycline 50 mg, 75 mg, 100 mg b.i.d. Minocycline 50 mg, 75 mg, 100 mg b.i.d. Erythromycin 500 mg b.i.d. Clarithromycin 250 mg b.i.d. Trimethoprim/sulfamethoxazole 80–400 mg, 160–800 mg b.i.d. Lower dosages are tried for maintenance • Isotretinoin most effective in early disease. • Surgical excision of sinus tracts may be necessary. • Weight loss helps. • Adalimumab, Infliximab, and Etanercept for severe cases.
