Hidradenitis suppurativa

Hidradenitis suppurativa (HS) —also called acne inversa —is a chronic inflammatory dermatosis of follicle-pilosebaceous/apocrine units, with deep nodules, abscesses, fistulous tunnels, and scarring in intertriginous areas. Goldburg 2020 , Nguyen 2021 .

• Names / synonyms
  • Hidradenitis suppurativa (HS)
  • Inverse acne
  • Verneuil ‘s disease
  • Other less commonly used terms: axillary hidradenitis, apocrine hidradenitis. Patil 2018 , Sabat 2020 .
• History
  • Clinically described by Velpeau in 1839 as “phlegmoneuse hydrosadenite”; later Verneuil related it to apocrine sweat glands in the second half of the 19th century. Patil 2018 .
• Epidemiology
  • Estimated global prevalence: 0.00033–4.1% ; best estimates for Europe/USA: 0.7–1.2% . Nguyen 2021 , Jfri 2021 .
  • Peak onset: 2nd–3rd decade of life , rare before puberty or after age 55. Jemec 2015 , Goldburg 2020 .
  • Sex: female predominance (≈2–4:1) in most series. Nguyen 2021 .
  • Higher frequency in people with obesity , smokers, and in some ethnic groups (particularly Black populations in US studies). Ingram 2020 , Nguyen 2021 .
  • High burden of comorbidities (metabolic, psychiatric, rheumatological). Tzellos 2020 , Garg 2022 .
• ICD codes
  • ICD-10: L73.2 – Hidradenitis suppurativa (WHO ICD-10). [show_150ms_ease-in] » data-testid=»webpage-citation-pill»> icd.who.int
  • ICD-11 (MMS): ED92.0 – Hidradenitis suppurativa as a disorder of skin appendages, according to clinical coding tables based on ICD-11 MMS.

• Diagnostic checklist (quick)
  • Essential clinic:
    • Painful nodules / deep abscesses in folds.
    • Chronic recurrence (repeated outbreaks in the same territory).
    • Double comedones, fistulous tracts, or bridging scars.
    • Reasonable exclusion of other causes (isolated furunculosis, Crohn’s disease, STDs).
  • Minimum laboratory:
    • BH, PCR/VSG.
    • Basic metabolic profile (glucose, lipids).
    • TB and hepatitis screening if biological testing is considered.
  • Cabinet:
    • Ultrasound of the affected area in moderate-to-severe disease or when there is doubt about the extent of the disease.
    • Pelvic MRI if complex perianal involvement.
  • Biopsy (when appropriate):
    • Indication: atypical presentation or suspected CEC.
    • Type: incisional/deep punch with dermis and subcutaneous tissue, or excisional if SCC is suspected.