GUIDELINES IN DERMATOLOGY

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HIDRADENITIS SUPPURATIVA

Zeynep Altan Ferhatoğlu1
Kadir Atacan Yıldız2

1İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Dermatology, İstanbul, Türkiye
2İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Dermatology, İstanbul, Türkiye

Altan Ferhatoğlu Z, Yıldız KA. Hidradenitis Suppurativa. In: Kutlubay Z, editor. Guidelines in Dermatology. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.93-101.

ABSTRACT

Hidradenitis suppurativa is a chronic inflammatory follicular skin disorder that primarily affects the intertriginous areas. Although prevalence varies, it has been reported as 0.05% to 4.1%. Patients typically present with inflammatory nodules and abscesses. Lesions can be located in various anatomical regions such as the axilla, inguinal region, inner thigh, scrotum, vulva, perianal and perineal regions, mammary and inframammary regions, buttocks, pubic region, retroauricular region, and the eyelid. The disease has devastating effects on the quality of life of the patients, with major impact on mental health and social well-being. In long-term disease, complications such as decreased joint mobility due to dermal contractures, vaginal/urethral/anal strictures, urethral fistula, lymphedema, elephantiasis, secondary amyloidosis, and squamous cell carcinoma may develop. Diagnosis depends on clinical features; typical lesions with typical localization and chronic course are of diagnostic importance. The most widely used system for staging is the Hurley clinical staging. There are a wide range of treatment modalities including lifestyle modifications, wound and skin care approaches, topical and intralesional treatments, systemic medications, and surgical procedures. It is recommended that all patients be screened for cardiovascular risk factors. Topical treatments include topical antibiotics, especially clindamycin, and topical keratolytics. Systemic medications include systemic antibiotics, chiefly oral tetracyclines, hormonal agents, systemic retinoids, immunosuppressive agents such as cyclosporine and corticosteroids, and biological treatments, particularly adalimumab. Clinical trials are being conducted with various biological agents in the treatment of hidradenitis suppurativa. The side effect profile and suitability of systemic treatments should be specifically evaluated in pediatric cases and pregnant women. Surgical procedures include incision and drainage in addition to more extensive procedures such as wide local excision. After excisional surgery, the wound can be left for secondary intention healing, or primary closure, delayed primary closure, or reconstruction with flaps or grafts or skin substitutes depending on the anatomic region can be preferred. In addition to these modalities, laser and energy-based devices can also be used, particularly in patients with fibrotic sinus tracts. The main goals of treatment are to decrease the incidence of new lesions, to treat the existing lesions, to provide symptomatic relief, and to reduce the impact of the disease on quality of life of the patient.

Keywords: Hidradenitis suppurativa; Tetracyclines; Retinoids; Adalimumab; Wide excision

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