BAGIAN ILMU KESEHATAN

KULIT DAN KELAMIN

FAKULTAS KEDOKTERAN
UNIVERSITAS HASANUDDIN

The Diagnostic and Treatments

of Hidradenitis Suppurativa
Presented by : Sausan Maulida C014182231
Astri Audia C014182277
Baru Juanna Cynthia XC064182032
Mutmainnah C11115054
Diana Arisandi C11113342

Resident : dr. Pipim Septiana

Supervisor : Prof. Dr. dr. Anis Irawan Anwar, Sp.KK(K), FINSDV, FAADV
Anatomy, Skin Sweat Glands
Apocrine Glands are short tubular glands,
composed of:

• Intra epidermal duct

• Intra dermal duct
• Secretory portion

Ductal portion leads to a pilosebaceous follicle

entering the infundibulum above the
sebaceous gland opening.
 Introduction

Hidradenitis suppurativa (HS) is a chronic inflammatory disease

originating from the apocrine gland. HS clinically characterized by
the formation of round nodules and abscess with hypertrophic
scarring and recursive suppuration, painful and occur mainly in
areas skin folds that have hair ends and apocrine glands occur
especially in areas of skin folds that have hair ends and apocrine
glands.
Definition

Hidradenitis Suppurativa is a chronic inflammatory skin

disease with supurative lesions on those parts of the
body that have apocrine glands and can deteriorate or
undergo periodic large inflammation.
Epidemiology

• Age : Puberty starts

• More in women than men
Etiology & Risk Factor
Unknown

 Staphylococcus aureus
Risk Factor :
1. Genetic
2. Hormon
3. Obesity
4. Bacterial infection
5. Smoking

Kang Sewon, et al. Fitzpatrick’s Dermatology, 9th edition. US: Mc Graw Hill Educaton. 2019
Pathogenesis
Apocrine occlusion (keratin occlusion)

ductal dilatation and glandular

component stasis Bacteria enter

the apocrine system quickly

multiplies Apocrine glands rupture

secondary bacterial infection wider

local inflammation, tissue destruction

,skin damage scarring & fibrosis

Clinical Manifestation
• Hidradenitis Suppurativa is localized in the apocrine gland-bearing areas of
the body such as axillae, inguinal and anogenital regions, perineum, and
inframammary area of female patients.
• Initial lession: abscesses / erythematous nodules with purulent or
seropurulent fluid and also with symptoms of intermittent pain.
• Advanced lession: fibrosis, sinus tract, hypertrophic scars

Hidradenitis suppurativa and metabolic syndrome: a comparative cross-sectional study of 3207 patients.Shalom G, Freud T, Harman-Boehm I, Polishchuk I, Cohen AD Br J Dermatol. 2015 Aug; 173(2):464-70.

Psychosocial impact of hidradenitis suppurativa: a qualitative study.Esmann S, Jemec GB Acta Derm Venereol. 2011 May; 91(3):328-32
Clinical Manifestation

Clinical Manifestations of Suppurative Hidradenitis in axillae, inguinal area

Diagnosis
The criteria for hidradenitis supurativa include:

 Typical lesions such as painful deep nodules “blind boils” in early

lesions, abscesses, sinuses, bridged scars, and double-ended
pseudo-comedones in secondary lesions.
Typical topography such as axillae, thighs, perianal region, buttocks,
infra and inter mamary folds
Chronic and recurrences

Fimmel S and Zouboulrs CC. Cormobities of Hidradenitis Suppurativa (Acne Inversa). Dermatoendocrinol.2010 Jan-Mar; 2(1): 9-16. Available from URL:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3084959/?tool=pmcentrez. Accesed on December 1st, 2019.
Hurley Classification
Grade I Grade II Grade III

Solitary or multiple abscesses witho Recurrent abscesses, solitary or Diffuse or extensive invol-vement of
ut a matrix or sinus multiple lesions that are far apart, the surrounding area with sinuses a
with sinuses nd interconnected abscesses

Fimmel S and Zouboulrs CC. Cormobities of Hidradenitis Suppurativa (Acne Inversa). Dermatoendocrinol.2010 Jan-Mar; 2(1): 9-16. Available from URL:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3084959/?tool=pmcentrez. Accesed on December 1st, 2019.
 Supporting Examination

There is no specific examination for hidradenitis suppurativa.

Cultures from exudates can grow various saprophytic bacteria and
pathogens such as staphylococcus and streptococcus. On laboratory
examination, patients with acute HS lesions can show an increase in the
rate of sedimentation of blood or C-reactive protein. If the patient
appears toxic or has a fever, a complete blood count, blood culture,
exudate culture, and routine chemistry are required.

Fite D. Hidradenitis Suppurativa in Emergency Medicine. May 2010. Emedicine. Available from URL: http://emedicine.medscape.com/article/762444-overview. Accesed
on December 2nd, 2019.
sofyan, M.A.2013 Hidradenitis Suppurativa. In Wolff K., Goldsmith, L.A., Katz, S.I. Gilcherts, B.A., Paller, A.S., Lefell, D.J.(Eds) ’Fitzpatrick’s Dermatology in
General Medicine’ Volume I. 7th Edition. USA: McGraw-Hill
Differential diagnosis

Skrofuloderma Furunkel & Lymphogranuloma Venerum

karbunkel

Wolff K, Goldsmith LA, Katz SI, et al. Fitzpatrick’s Dermatology in General Medicine, 7th edition. US: Mc Graw Hill Medical. 2008. Pyoderma: Hidradenitis. Dalam
Adhi Djuanda (Ed). Ilmu Penyakit Kulit dan Kelamin Edisi ke-7. Jakarta : FKUI.
Treatments
Non-pharmacologic :
• If obese or overweight, weight reduction
• Reduce friction by wearing loose-fitting clothing,
• Heat avoidance.
• Antiseptic soaps
• Smoking cessation

James WD, Elston DM, et al. Andrews’ Disease of the Skin Clinical Dermatology, 13th edition
Medical therapy
Topical Oral
 Early inflammatory lesions : steroid  Antobiotic : clindamycin and
therapy Intralesional rifampin (300 mg / 2 to 3 times daily)
triamcinolone (5 mg/ml) or Eritromycin, tetracyclin,
minocycline
 Clindamycin 1 % lotion applied twice
daily  Corticosteroid oral ( severe case )

 Eradication of S. aureuscarriage with

topical mupirocin in nose, axillae,
umbilicus, and perianal regio
Kang Sewon, et al. Fitzpatrick’s Dermatology, 9th edition. US: Mc Graw Hill Educaton. 2019
Callen JP, et al. Bolognia Dermatology 4th edition. US: Elseiver. 2017.
Surgery
Excisional surgery
- milder disease, simple incision and drainage proce-
dures, local excisions, and/or deroofing of sinus tracts
typically suffice.
- More-severe disease will likely require wide local
excisions with primary closure, split-thickness grafting,
flap advancements, and/or healing by secondary intention
Laser therapy

Kang Sewon, et al. Fitzpatrick’s Dermatology, 9th edition. US: Mc Graw Hill Educaton. 2019
Prognosis
The severity of this disease varies greatly. Many patients only
experience mild symptoms, HS usually experiences spontaneous
remission at age> 35 years.

In some patients the symptoms can be progressive, with marked

morbidity associated with chronic disease, sinus formation, and
a scarring that causes limited movement.
Conclussion
• Hidradenitis supurativa : chronic inflammatory disorder of the apocrine gland.
characterized by recurrent abscess formation.

• starts at or soon after puberty, women are affected three times as often as men.

• Risk factors : bacterial infection, genetic, hormonal obesity and smoking.

• Diagnosis : clinical manifestations Diagnostic Criteria : 1. Typical lesion (1 or

more): painful nodules, abscesses, draining sinuses, double-open comedones, bridged
scars, 2. Typical distribution : axillae, groin, buttocks, perineal, and infra-mammary
regions and 3. Chronicity and recurrenceof symptoms. And also laboratory, radiology
and histopathology.

• Treatment : A therapeutic approach to hidradenitis suppurativa, based on disease

severity.
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