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Hidradenitis suppurativa (acne inversa): Treatment

Author
John R Ingram, MD, PhD
Section Editors
Robert P Dellavalle, MD, PhD, MSPH
Mark V Dahl, MD
Deputy Editor
Abena O Ofori, MD

INTRODUCTION

Hidradenitis suppurativa/acne inversa (HS/AI) is a chronic, painful, follicular occlusive disease that affects the folliculopilosebaceous unit, mainly but not exclusively in intertriginous axillary, groin, perianal, perineal, genital, and inframammary skin. The clinical course is highly variable, ranging from relatively mild cases characterized by the recurrent appearance of papules, pustules, and a few inflammatory nodules to severe cases demonstrating deep fluctuant abscesses, draining sinuses, and severe rope-like scars (picture 1A).

The management and prognosis of HS/AI will be reviewed here. Information on the pathogenesis, clinical features, and diagnosis of HS/AI and a detailed discussion of the surgical techniques used in the treatment of HS/AI are provided separately. (See "Hidradenitis suppurativa (acne inversa): Pathogenesis, clinical features, and diagnosis" and "Surgical management of hidradenitis suppurativa (acne inversa)".)

PRINCIPLES

The pain, odor, drainage, and disfigurement caused by HS/AI profoundly affects quality of life [1]. Patients often experience feelings of sadness or depression related to the disease, and feelings of shame may contribute to self-imposed social isolation [2-4]. Diagnostic delay, which averages seven years, combined with the significant physical and emotional toll of HS/AI, may lead to patient frustration with medical care [5].

Treatment goals — Untreated, HS/AI can remain active for many years after onset, which is typically in early adulthood. Interventions for HS target one or more of three major goals:

To reduce the frequency of new lesions, minimizing pain and suppuration

                                          
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Literature review current through: Sep 2017. | This topic last updated: Oct 06, 2017.
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References
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