Dermatologic Emergencies

dermatology-emergencieskapak-1-0-25

Hidradenitis Suppurativa

Melih ÇAMCI
Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara Bilkent City Hospital, Department of Emergency Medicine, Ankara, Türkiye

Çamcı M. Hidradenitis suppurativa. In: Oğuztürk H, Görmeli Kurt N, eds. Dermatologic Emergencies. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.131-9.

ABSTRACT

Hidradenitis suppurativa (HS) is a chronic inflammatory dermatological condition characterized by the formation of painful nodules, abscesses, and sinus tracts, primarily affecting intertriginous regions such as the axillae and groin. Due to its similarity to infections, HS is often misdiagnosed, which leads to delays in proper treatment. The condition has a substantial impact on both physical health and mental well-being, contributing to reduced quality of life, depression, and social withdrawal. Early detection is crucial to slowing disease progression and improving outcomes. Management options include pain control, topical and oral antibiotics, biologic treatments, and surgery in severe cases. Ongoing management by a multidisciplinary team, including dermatologists, pain management specialists, and mental health professionals, is crucial for optimal patient care. Treatment strategies should be individualized to meet the specific needs of each patient, targeting both the physical symptoms and the psychological impact of the disease. Timely referral to dermatology, ideally within three months of diagnosis, improves patient outcomes and reduces emergency department visits.

Keywords: Hidradenitis suppurativa; emergency department; chronic skin disease; diagnosis; disease management

Referanslar

  1. González-López MA. Hidradenitis suppurativa. Med Clin (Barc). 2024;162(4):182-9. [Crossref]  [PubMed]
  2. Stancic BH, Boer j, Dolenc-Voljč M, jemec GBE. The Role of Intra-Follicular Shear Forces in Hidradenitis Suppurativa. Skin Pharmacol Physiol. 2023;36(6):302-3. [Crossref]  [PubMed]
  3. Cosmatos I, Matcho A, weinstein R, Montgomery MO, Stang P. Analysis of patient claims data to determine the prevalence of hidradenitis suppurativa in the United States. j Am Acad Dermatol. 2013;68(3):412-9. [Crossref]  [PubMed]
  4. Garg A, Lavian j, Lin G, Strunk A, Alloo A. Incidence of hidradenitis suppurativa in the United States: A sex- and age-adjusted population analysis. j Am Acad Dermatol. 2017;77(1):118-22. [Crossref]  [PubMed]
  5. Garg A, Neuren E, Cha D, Kirby jS, Ingram jR, jemec GBE, et al. Evaluating patients' unmet needs in hidradenitis suppurativa: results from the global survey of impact and healthcare needs (VOICE) project. j Am Acad Dermatol. 2020;82(2):366-76. [Crossref]  [PubMed]
  6. Tran H, Chen K, Lim AC, jabbour j, Shumack S. Assessing diagnostic skill in dermatology: a comparison between general practitioners and dermatologists. Australas j Dermatol. 2005;46(4):230-4. [Crossref]  [PubMed]
  7. Hoffman LK, Ghias MH, Lowes MA. Pathophysiology of hidradenitis suppurativa. Semin Cutan Med Surg. 2017;36(2):47-54. [Crossref]  [PubMed]
  8. Ring HC, Theut Riis P, Zarchi K, Miller IM, Saunte DM, jemec GB. Prodromal symptoms in hidradenitis suppurativa. Clin Exp Dermatol. 2017;42(3):261-5. [Crossref]  [PubMed]
  9. Kirby j, Kim K, Zivkovic M, wang S, Garg V, Danavar A, et al. Uncovering the burden of hidradenitis suppurativa misdiagnosis and underdiagnosis: a machine learning approach. Front Med Technol. 2024;6:1200400. [Crossref]  [PubMed]  [PMC]
  10. Singh S, Desai K, Gillern S. Management of Pilonidal Disease and Hidradenitis Suppurativa. Surg Clin North Am. 2024;104(3):503-15. [Crossref]  [PubMed]
  11. Taira BR, Singer Aj, Thode HC jr, Lee CC. National epidemiology of cutaneous abscesses: 1996 to 2005. Am j Emerg Med. 2009;27(3):289-92. [Crossref]  [PubMed]
  12. Kokolakis G, wolk K, Schneider-Burrus S, Kalus S, Barbus S, Gomis-Schneider S, et al. Delayed Diagnosis of Hidradenitis Suppurativa and Its Effect on Patients and Healthcare System. Dermatology. 2020;236(5):421-30. [Crossref]  [PubMed]  [PMC]
  13. Rui P, Kang K. National Hospital Ambulatory Medical Care Survey: 2017 emergency department summary tables. National Center for Health Statistics. Accessed Sept 10, 2024. [Link]
  14. Jfri A, Nassim D, O'Brien E, Gulliver w, Nikolakis G, Zouboulis CC. Prevalence of Hidradenitis Suppurativa: A Systematic Review and Meta-regression Analysis. jAMA Dermatol. 2021157(8):924-31. [Crossref]  [PubMed]  [PMC]
  15. Sinikumpu SP, jokelainen j, Huilaja L. Prevalence and Characteristics of Hidradenitis Suppurativa in the Northern Finland Birth Cohort 1986 Study: A Cross-sectional Study of 2,775 Subjects. Acta Derm Venereol. 2024;104:adv14732. [Crossref]  [PubMed]  [PMC]
  16. Greif C, Gibson RS, Kimball AB, Holcomb ZE, Porter ML. Evaluating minority representation across health care settings in hidradenitis suppurativa and psoriasis. Int j womens Dermatol. 2024;10(1):e129. [Crossref]  [PubMed]  [PMC]
  17. Taylor MT, Orenstein LAV, Barbieri jS. Pain Severity and Management of Hidradenitis Suppurativa at US Emergency Department Visits. jAMA Dermatol. 2021;157(1):115-7. [Crossref]  [PubMed]  [PMC]
  18. Balić A, Marinović B, Bukvić Mokos Z. The genetic aspects of hidradenitis suppurativa. Clin Dermatol. 2023;41(5):551-63. [Crossref]  [PubMed]
  19. Brandão LAC, Tricarico PM, Gratton R, Agrelli A, Zupin L, Abou-Saleh H, et al. Multiomics Integration in Skin Diseases with Alterations in Notch Signaling Pathway: PlatOMICs Phase 1 Deployment. Int j Mol Sci. 2021;22(4):1523. [Crossref]  [PubMed]  [PMC]
  20. Sun Q, Broadaway KA, Edmiston SN, Fajgenbaum K, Miller-Fleming T, westerkam LL, et al. Genetic Variants Associated with Hidradenitis Suppurativa. jAMA Dermatol. 2023;159(9):930-8. [Crossref]  [PubMed]  [PMC]
  21. Chu YL, Yu S. Hidradenitis Suppurativa: An Understanding of Genetic Factors and Treatment. Biomedicines. 2024;12(2):338. [Crossref]  [PubMed]  [PMC]
  22. Miller IM, McAndrew Rj, Hamzavi I. Prevalence, Risk Factors, and Comorbidities of Hidradenitis Suppurativa. Dermatol Clin. 2016;34(1):7-16. [Crossref]  [PubMed]
  23. Vossen ARjV, van Straalen KR, Swolfs EFH, van den Bosch jF, Ardon CB, van der Zee HH. Nicotine Dependency and Readiness to Quit Smoking among Patients with Hidradenitis Suppurativa. Dermatology. 2021;237(3):383-5. [Crossref]  [PubMed]
  24. Nowak-Liduk A, Kitala D, Ochała-Gierek G, Łabuś w, Bergler-Czop B, Pietrauszka K, et al. Hidradenitis Suppurativa: An Interdisciplinary Problem in Dermatology, Gynecology, and Surgery-Pathogenesis, Comorbidities, and Current Treatments. Life (Basel). 2023;13(9):1895. [Crossref]  [PubMed]  [PMC]
  25. Garg A, Malviya N, Strunk A, wright S, Alavi A, Alhusayen R, et al. Comorbidity screening in hidradenitis suppurativa: evidence-based recommendations from the US and Canadian hidradenitis Suppurativa foundations. j Am Acad Dermatol. 2022;86(5):1092-101. [Crossref]  [PubMed]  [PMC]
  26. van Straalen KR, Prens EP, Gudjonsson jE. Insights into hidradenitis suppurativa. j Allergy Clin Immunol. 2022;149(4):1150-61. [Crossref]  [PubMed]
  27. Prens E, Deckers I. Pathophysiology of hidradenitis suppurativa: An update. j Am Acad Dermatol. 2015;73(5 Suppl 1):S8-S11. [Crossref]  [PubMed]
  28. van der Zee HH, Laman jD, Boer j, Prens EP. Hidradenitis suppurativa: viewpoint on clinical phenotyping, pathogenesis and novel treatments. Exp Dermatol. 2012;21(10):735-9. [Crossref]  [PubMed]
  29. Tan Ij, Podwojniak A, Parikh A, Cohen BA. Precision Dermatology: A Review of Molecular Biomarkers and Personalized Therapies. Curr Issues Mol Biol. 2024;46(4):2975-90. [Crossref]  [PubMed]  [PMC]
  30. Gierek M, Ochała-Gierek G, Kitala D, Łabuś w, Bergler-Czop B. Hidradenitis suppurativa: bacteriological study in surgical treatment. Postepy Dermatol Alergol. 2022;39(6):1101-5. [Crossref]  [PubMed]  [PMC]
  31. Smith SDB, Okoye GA, Sokumbi O. Histopathology of Hidradenitis Suppurativa: A Systematic Review. Dermatopathology (Basel). 2022;9(3):251-7. [Crossref]  [PubMed]  [PMC]
  32. Reddy S, Schwartzman G, Luu LA, Im G, Flowers RH, Guffey Dj. Differentiating hidradenitis suppurativa flare from infection in the emergency department and recommendations for transitioning care to the outpatient setting. Am j Emerg Med. 2024;79:58-62. [Crossref]  [PubMed]
  33. Ballard K, Shuman VL. Hidradenitis Suppurativa. [Updated 2024 May 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 jan. Available from: [Link]
  34. Garg A, Reddy S, Kirby j, Strunk A. Development and validation of HSCAPS1: a clinical decision support tool for diagnosis of hidradenitis Suppurativa over cutaneous abscess. Dermatology (Basel, Switzerland). 2021;237(5):719-26. [Crossref]  [PubMed]
  35. Okun MM, Flamm A, werley EB, Kirby jS. Hidradenitis Suppurativa: Diagnosis and Management in the Emergency Department. j Emerg Med. 2022;63(5):636-44. [Crossref]  [PubMed]
  36. Riva H, Hendricks A, Yoon T, Del Coro Amengual C, Maddox C. Decades Delayed in Diagnosis: Hidradenitis Suppurativa and a Review of Barriers to Care. Cureus. 2024;16(3):e56231. [Crossref]  [PubMed]
  37. Miller A, Shahzeidi P, Bernhardt M. An Update on Current Clinical Management and Emerging Treatments in Hidradenitis Suppurativa. Skin Therapy Lett. 2024;29(2):1-6. [Link]
  38. Mendes-Bastos P, Martorell A, Bettoli V, Matos AP, Muscianisi E, wortsman x. The use of ultrasound and magnetic resonance imaging in the management of hidradenitis suppurativa: a narrative review. Br j Dermatol. 2023;188(5):591-600. [Crossref]  [PubMed]
  39. Zouboulis C, Tzellos T, Kyrgidis A, jemec G, Bechara F, Giamarellos-Bourboulis E, et al. Development and validation of the International Hidradenitis Suppurativa Severity Score System (IHS4), a novel dynamic scoring system to assess HS severity. Br j Dermatol. 2017;177(5):1401-9. [Crossref]  [PubMed]
  40. Alikhan A, Sayed C, Alavi A, Alhusayen R, Brassard A, Burkhart C, et al. North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part II: Topical, intralesional, and systemic medical management. j Am Acad Dermatol. 2019;81(1):91-101. [Crossref]  [PubMed]  [PMC]
  41. Hessam S, Sand M, Gambichler T, Bechara FG. Correlation of inflammatory serum markers with disease severity in patients with hidradenitis suppurativa (HS). j Am Acad Dermatol. 2015;73(6):998-1005. [Crossref]  [PubMed]
  42. Garelik j, Babbush K, Ghias M, Cohen SR. Efficacy of high-dose intralesional triamcinolone for hidradenitis suppurativa. Int j Dermatol. 2021;60(2):217- 21. [Crossref]  [PubMed]
  43. Jørgensen AR, Yao Y, Thomsen SF, Ring HC. Treatment of hidradenitis suppurativa with tetracycline, doxycycline, or lymecycline: a prospective study. Int j Dermatol. 2021;60(7):785-91. [Crossref]  [PubMed]
  44. Blum FR, Paci KM, Sayed Cj. Use of a punch biopsy tool as an alternative approach for incision and drainage of abscesses. j Am Acad Dermatol. 2022;86(4):e141-e2. [Crossref]  [PubMed]
  45. Stergianou D, Kanni T, Damoulari C, Giamarellos-Bourboulis Ej. An evaluation of secukinumab for the treatment of moderate-to-severe hidradenitis suppurativa. Expert Opin Biol Ther. 2024;24(4):225-32. [Crossref]  [PubMed]
  46. Clark SR, Soti V. Effectiveness of Surgical Deroofing and Carbon Dioxide Laser in Moderate-to-Severe Hidradenitis Suppurativa Patients. Cureus. 2024;16(3):e56959. [Crossref]  [PubMed]
  47. Richards E, joshi A. Psychosocial effects of hidradenitis suppurativa in the literature: A systematic review. Int j Psychiatry Med. 2025;60(1):97-110. [Crossref]  [PubMed]
  48. Mac Mahon j, Murray G, McCartney Y, Crowther S, Tobin AM, Molloy K. Systemic AA amyloidosis in hidradenitis suppurativa: Should we be screening? j Eur Acad Dermatol Venereol. 2023;37(5):e600-e1. [Crossref]  [PubMed]
  49. Yuan jT, Naik HB. Complications of hidradenitis suppurativa. Semin Cutan Med Surg. 2017;36(2):79-85. [Crossref]  [PubMed]
  50. Wang Cx, Buss jL, Keller M, Anadkat Mj. Factors Associated with Dermatologic Follow-up vs Emergency Department Return in Patients with Hidradenitis Suppurativa After an Initial Emergency Department Visit. jAMA Dermatol. 2022;158(12):1378-86. [Crossref]  [PubMed]  [PMC]