Hidradenitis suppurativa: Difference between revisions
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==Background== | ==Background== | ||
{{Skin anatomy background images}} | |||
*Inflammatory condition involving the apocrine gland-bearing areas of skin, characterized by recurrent painful draining nodules.<ref>Morrell D, Bowers E. Skin disorders: Groin and skinfolds. In Tintinalli J,ed. Tintinalli's Emergency Medicine: A Comprehensive Study Guide (8th ed). New York: McGraw Hill Medical; 2011: 1669-70.</ref> | *Inflammatory condition involving the apocrine gland-bearing areas of skin, characterized by recurrent painful draining nodules.<ref>Morrell D, Bowers E. Skin disorders: Groin and skinfolds. In Tintinalli J,ed. Tintinalli's Emergency Medicine: A Comprehensive Study Guide (8th ed). New York: McGraw Hill Medical; 2011: 1669-70.</ref> | ||
*More common in women and black or biracial individuals.<ref>Garg A, et al. JAMA Dermatol. 2017;153:760–4.</ref> | *More common in women and black or biracial individuals.<ref>Garg A, et al. JAMA Dermatol. 2017;153:760–4.</ref> | ||
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==Clinical Features== | ==Clinical Features== | ||
[[File:Hidradenitis.png|thumb|Hidradenitis suppurativa of armpit]] | |||
[[File:Lesions from hidradenitis suppurativa.jpg.jpg|thumb|Hidradenitis suppurativa]] | |||
[[File:Acne inversa mit Abszess, Hurley-Stadium II, ©WIKDERM.jpg|thumb|Armpit with hidradenitis suppurativa.]] | |||
[[File:HS Hidradenitis Suppurativa.jpg|thumb|Infected area of hidradenitis suppurativa with underlying pus.]] | |||
*Tender, nodular lesions most often in the axillae (can also affect gluteal folds, inframammary areas, perianal area, and pubic/genitofemoral areas) | *Tender, nodular lesions most often in the axillae (can also affect gluteal folds, inframammary areas, perianal area, and pubic/genitofemoral areas) | ||
*Malodorous drainage | *Malodorous drainage | ||
*Pruritis | *[[Pruritis]] | ||
*Burning | *Burning | ||
*Erythema | *Erythema | ||
*Hyperhidrosis | *Hyperhidrosis | ||
*Scarring<ref>*Shah, N. Hidradenitis suppurativa: A treatment challenge. Am Fam Physician. 2005 Oct 15;72(8):1547-1552.</ref> | *Scarring<ref>*Shah, N. Hidradenitis suppurativa: A treatment challenge. Am Fam Physician. 2005 Oct 15;72(8):1547-1552.</ref> | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Epidermoid or dermoid cyst | *Epidermoid or dermoid cyst | ||
* | *Inflammatory acne | ||
*[[Granuloma inguinale]] | *[[Granuloma inguinale]] | ||
*[[Lymphogranuloma venereum]] | *[[Lymphogranuloma venereum]] | ||
{{SSTI DDX}} | |||
==Evaluation== | ==Evaluation== | ||
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*[[Clindamycin]] 1% topic | *[[Clindamycin]] 1% topic | ||
*Antibacterial soaps | *Antibacterial soaps | ||
*Systemic treatments (typically prescribed by specialist): acitretin, finasteride, prednisone | *Systemic treatments (typically prescribed by specialist): acitretin, finasteride, [[prednisone]] | ||
*[[Incision and drainage]] should be avoided if possible due to risk of scarring<ref>Morrell D, Bowers E. Skin disorders: Groin and skinfolds. In Tintinalli J,ed. Tintinalli's Emergency Medicine: A Comprehensive Study Guide (8th ed). New York: McGraw Hill Medical; 2011: 1669-70.</ref> | *[[Incision and drainage]] should be avoided if possible due to risk of scarring<ref>Morrell D, Bowers E. Skin disorders: Groin and skinfolds. In Tintinalli J,ed. Tintinalli's Emergency Medicine: A Comprehensive Study Guide (8th ed). New York: McGraw Hill Medical; 2011: 1669-70.</ref> | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Dermatology]] | |||
Latest revision as of 16:26, 11 December 2024
Background
- Inflammatory condition involving the apocrine gland-bearing areas of skin, characterized by recurrent painful draining nodules.[1]
- More common in women and black or biracial individuals.[2]
- Rarely occurs before puberty. Peak age of onset is 11–20 yo in women and 21–30 yo in men.[3]
Clinical Features
- Tender, nodular lesions most often in the axillae (can also affect gluteal folds, inframammary areas, perianal area, and pubic/genitofemoral areas)
- Malodorous drainage
- Pruritis
- Burning
- Erythema
- Hyperhidrosis
- Scarring[4]
Differential Diagnosis
- Epidermoid or dermoid cyst
- Inflammatory acne
- Granuloma inguinale
- Lymphogranuloma venereum
Skin and Soft Tissue Infection
- Cellulitis
- Erysipelas
- Lymphangitis
- Folliculitis
- Hidradenitis suppurativa
- Skin abscess
- Necrotizing soft tissue infections
- Mycobacterium marinum
Look-A-Likes
- Sporotrichosis
- Osteomyelitis
- Deep venous thrombosis
- Pyomyositis
- Purple glove syndrome
- Tuberculosis (tuberculous inflammation of the skin)
Evaluation
- Clinical diagnosis: skin nodules in characteristic sites, may have malodorous drainage
- Diagnosis may be difficult in the ED if single nodule is present.
Management
- Clindamycin 1% topic
- Antibacterial soaps
- Systemic treatments (typically prescribed by specialist): acitretin, finasteride, prednisone
- Incision and drainage should be avoided if possible due to risk of scarring[5]
Disposition
- Discharge with primary care/dermatology followup
See Also
External Links
References
- ↑ Morrell D, Bowers E. Skin disorders: Groin and skinfolds. In Tintinalli J,ed. Tintinalli's Emergency Medicine: A Comprehensive Study Guide (8th ed). New York: McGraw Hill Medical; 2011: 1669-70.
- ↑ Garg A, et al. JAMA Dermatol. 2017;153:760–4.
- ↑ Palmer R, Keefe M. Clin Dermatol. 2001;26:501–3.
- ↑ *Shah, N. Hidradenitis suppurativa: A treatment challenge. Am Fam Physician. 2005 Oct 15;72(8):1547-1552.
- ↑ Morrell D, Bowers E. Skin disorders: Groin and skinfolds. In Tintinalli J,ed. Tintinalli's Emergency Medicine: A Comprehensive Study Guide (8th ed). New York: McGraw Hill Medical; 2011: 1669-70.