The n e w e ng l a n d j o u r na l of m e dic i n e

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Chana A. Sacks, M.D., Editor

Clinical Diagnosis of Hidradenitis

Suppurativa
A B

Anna Beltrame, M.D., Ph.D.

Silvia Staffolani, M.D.
Sacro Cuore Don Calabria Hospital
Negrar, Italy
anna.beltrame@sacrocuore.it

A
27-year-old man presented to the Center for Tropical Diseases at our hospital with a 2-year
history of acne and the recurrence of multiple painful lesions in the genital and perineal areas. He had pre-
viously been treated with multiple courses of antibiotic agents and with surgical treatments (repeated
attempts to incise and drain) without resolution. Examination revealed inflamed and noninflamed nodules and scar
tissue in the genitofemoral area (Panel A) and axilla (Panel B), as well as in the intergluteal area and behind the ears.
A clinical diagnosis of hidradenitis suppurativa (Hurley stage II, on a scale of I to III, with higher stages indicating
more abscesses and a greater affected region) was made. Hidradenitis suppurativa is a chronic, inflammatory, recur-
rent skin disease of the hair follicles. The cause of hidradenitis suppurativa is unclear, involving multiple causal
factors, such as genetic and environmental factors. It usually manifests after puberty with painful, deep-seated,
inflamed lesions in the apocrine gland–bearing areas of the body, most commonly the axillae and the inguinal and
anogenital regions. Delays in diagnosis are common, because lesions are often initially mistaken for simple infec-
tions. Lesions may be slow to heal and may lead to sinus tracts and scarring. Treatment includes a combination of
surgery and topical and systemic antibiotics (often doxycycline or rifampin combined with clindamycin); in severe
cases, systemic immunosuppressive agents may be considered. The patient underwent 2 weeks of systemic anti-
biotic therapy and began a lifestyle-modification program that included smoking cessation. No improvement in his
condition was noted. The patient was advised to go to a referral center for dermatology that focused on hidradenitis
suppurativa. The patient was lost to follow-up.
DOI: 10.1056/NEJMicm1707912
Copyright © 2017 Massachusetts Medical Society.

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