hidradenitis suppurativa

see also:

• skin_abcess
• perianal abscess

• a chronic follicular occlusive disease that affects the intertriginous axillary, groin, perianal, perineal, and inframammary skin

• stage I: abscess formation without sinus tracts or scarring
• stage II: recurrent abscesses with tract formation and scarring
• stage III: diffuse or near diffuse involvement, or multiple interconnected sinus tracts and abscesses across the entire area

• wear loose, light clothing to aid in the avoidance of excessive heat, friction, and shearing trauma
• daily gentle cleansing of affected areas may help to reduce odor and the occurrence of secondary infection
• stop smoking
• weight reduction if obese
• diet: ? role of avoiding milk and high glycaemic foods

• topical clindamycin
• intralesional corticosteroids
• short course oral doxycycline, clindamycin or amoxycillin/clavulanic acid for acute flare ups
• 2nd line:
  • consider adding either:
    • rifampicin + moxifloxacin + metronidazole
    • dapsone
    • antiandrogens such as cyproterone acetate
    • short 3-4 day course of corticosteroids
• 3rd line:
  • consider trial of:
    • TNF-alpha inhibitors such as infliximab
    • oral retinoids such as acitretin or isotretinoin (Roaccutane)

• incision and drainage - probably should be avoided unless severe pain from a tense abscess as only of short term benefit and results in recurrence
• wide excision for stage III disease
• ?role of botulinum toxin