Hidradenitis Suppurativa Diagnosis and Management

Clinical Presentation and Epidemiology

The American Academy of Dermatology recommends diagnosis of Hidradenitis Suppurativa based on three clinical findings: typical HS lesions, predilection for intertriginous body sites, and recurrent disease pattern 1
Hidradenitis Suppurativa predominantly affects patients in their third and fourth decades of life, with female preponderance 1
The prevalence of Hidradenitis Suppurativa ranges from 0.1% to 2% of the population, with approximately 1% prevalence in European studies 1, 2
There is a higher prevalence of Hidradenitis Suppurativa in patients of African descent and lower socioeconomic status 1
The American Academy of Dermatology notes a strong association between Hidradenitis Suppurativa and smoking and obesity, which are critical modifiable risk factors 3

The Hurley staging system is the recommended clinical classification system for Hidradenitis Suppurativa, with three stages: Hurley Stage I (recurrent nodules and abscesses with minimal scarring), Hurley Stage II (one or limited number of sinuses and/or scarring within a body region), and Hurley Stage III (multiple or extensive sinuses and/or scarring) 3
The pathogenesis of Hidradenitis Suppurativa involves genetic susceptibility, dysregulation of innate and adaptive immune pathways, and microbiome alterations and biofilm formation 1, 3

The American Academy of Dermatology recommends viewing Hidradenitis Suppurativa as a systemic inflammatory disease with significant comorbidities, including metabolic syndrome and diabetes, depression and anxiety, and cardiovascular disease risk factors 3
Patients with Hidradenitis Suppurativa are at increased risk of developing squamous cell carcinoma in chronic HS-affected skin 3

The American Academy of Dermatology recommends combining medical and surgical approaches for the management of Hidradenitis Suppurativa, based on disease severity 4
Mild disease (Hurley I) can be treated with topical clindamycin 1% twice daily for 12 weeks, combined with antiseptic washes (chlorhexidine 4% or benzoyl peroxide) 4
Moderate disease (Hurley II) can be treated with clindamycin 300 mg twice daily plus rifampicin 300-600 mg daily for 10-12 weeks 4
Severe disease (Hurley III) requires adalimumab (160 mg at week 0, 80 mg at week 2, then 40 mg weekly) with surgical consultation for definitive management 4
Adjunctive measures, such as smoking cessation, weight management, pain management with NSAIDs and appropriate wound dressings, and screening and treatment for depression/anxiety and cardiovascular risk factors, are essential for optimal management 4, 6