Hidradenitis suppurativa (HS) is a chronic follicular occlusive disease that affects the intertriginous axillary, groin, perianal, perineal, 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 band-like scars.
The management and prognosis of HS will be reviewed here. The pathogenesis, clinical features, and diagnosis of this disorder are discussed separately. (See "Pathogenesis, clinical features, and diagnosis of hidradenitis suppurativa".)
Although HS is not life-threatening, the pain, odor, drainage, and disfigurement associated with this disorder regularly have deleterious effects on patient quality of life. Patients often experience feelings of sadness or depression related to the disease, and feelings of shame may contribute to self-imposed social isolation [1-4]. Because of the significant physical and emotional toll of HS, treatment is often aggressively sought by patients, sometimes despite past therapeutic disappointments.
Treatment goals — In the absence of successful treatment, HS can remain active for many years. The treatments for HS target one or more of three major goals:
- To reduce the extent and progression of disease by healing existing inflammatory lesions and preventing the formation of new lesions
- To remove chronic sinuses
- To limit scar formation