Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Treatment of hidradenitis suppurativa (acne inversa)

INTRODUCTION

Hidradenitis suppurativa/acne inversa (HS/AI) is a chronic follicular occlusive disease that affects the folliculopilosebaceous unit (FPSU), 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 band-like scars.

The management and prognosis of HS/AI 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 (acne inversa)".)

PRINCIPLES

Although HS/AI 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/AI, patients often aggressively seek treatment, sometimes despite past diagnostic and therapeutic disappointments.

Acne vulgaris, the less serious clinical variant of HS/AI, has been strongly associated with the "Western diet" [5], a dairy-laden and calorie-dense food style that is also the basis of the metabolic syndrome, a constellation of risk factors (ie, obesity, dyslipidemia, hyperglycemia, hypertension) for diabetes and cardiovascular disease. We propose that the same contributory dietary factors operating in acne vulgaris play an identical role in the genesis of both HS/AI and metabolic syndrome, though each may exist independently. Clinicians managing diets in patients with HS/AI [6,7] should be aware that HS/AI patients who demonstrate an elevated body mass index often have increased risk for these comorbidities [8,9]. (See "The metabolic syndrome (insulin resistance syndrome or syndrome X)".)

Treatment goals — In the absence of successful measures for prevention and treatment of the clinical manifestations of HS/AI, the disease can remain active for many years. The treatments for HS target one or more of three major goals:

                                        

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2014. | This topic last updated: Nov 19, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Wolkenstein P, Loundou A, Barrau K, et al. Quality of life impairment in hidradenitis suppurativa: a study of 61 cases. J Am Acad Dermatol 2007; 56:621.
  2. Matusiak L, Bieniek A, Szepietowski JC. Psychophysical aspects of hidradenitis suppurativa. Acta Derm Venereol 2010; 90:264.
  3. Esmann S, Jemec GB. Psychosocial impact of hidradenitis suppurativa: a qualitative study. Acta Derm Venereol 2011; 91:328.
  4. Kurek A, Peters EM, Chanwangpong A, et al. Profound disturbances of sexual health in patients with acne inversa. J Am Acad Dermatol 2012; 67:422.
  5. Melnik BC, Zouboulis CC. Potential role of FoxO1 and mTORC1 in the pathogenesis of Western diet-induced acne. Exp Dermatol 2013; 22:311.
  6. Margesson LJ, Danby FW. Hidradenitis suppurativa. Best Pract Res Clin Obstet Gynaecol 2014.
  7. Melnik B. Dietary intervention in acne: Attenuation of increased mTORC1 signaling promoted by Western diet. Dermatoendocrinol 2012; 4:20.
  8. Gold DA, Reeder VJ, Mahan MG, Hamzavi IH. The prevalence of metabolic syndrome in patients with hidradenitis suppurativa. J Am Acad Dermatol 2014; 70:699.
  9. Miller IM, Ellervik C, Vinding GR, et al. Association of Metabolic Syndrome and Hidradenitis Suppurativa. JAMA Dermatol 2014.
  10. Danby FW, Margesson LJ. Hidradenitis suppurativa. Dermatol Clin 2010; 28:779.
  11. Hurley HJ. Axillary hyperhidrosis, apocrine bromhidrosis, hidradenitis suppurativa, and familial benign pemphigus: surgical approach. In: Dermatologic surgery, Roenigk RK, Roenigk HH (Eds), Dekker, New York 1989. p.729.
  12. Sartorius K, Lapins J, Emtestam L, Jemec GB. Suggestions for uniform outcome variables when reporting treatment effects in hidradenitis suppurativa. Br J Dermatol 2003; 149:211.
  13. Sartorius K, Emtestam L, Jemec GB, Lapins J. Objective scoring of hidradenitis suppurativa reflecting the role of tobacco smoking and obesity. Br J Dermatol 2009; 161:831.
  14. Sartorius K, Killasli H, Heilborn J, et al. Interobserver variability of clinical scores in hidradenitis suppurativa is low. Br J Dermatol 2010; 162:1261.
  15. Jemec GB. Clinical practice. Hidradenitis suppurativa. N Engl J Med 2012; 366:158.
  16. Onderdijk AJ, van der Zee HH, Esmann S, et al. Depression in patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2013; 27:473.
  17. Revuz JE, Canoui-Poitrine F, Wolkenstein P, et al. Prevalence and factors associated with hidradenitis suppurativa: results from two case-control studies. J Am Acad Dermatol 2008; 59:596.
  18. Canoui-Poitrine F, Revuz JE, Wolkenstein P, et al. Clinical characteristics of a series of 302 French patients with hidradenitis suppurativa, with an analysis of factors associated with disease severity. J Am Acad Dermatol 2009; 61:51.
  19. König A, Lehmann C, Rompel R, Happle R. Cigarette smoking as a triggering factor of hidradenitis suppurativa. Dermatology 1999; 198:261.
  20. Simonart T. Hidradenitis suppurativa and smoking. J Am Acad Dermatol 2010; 62:149.
  21. Arun B, Loffeld A. Long-standing hidradenitis suppurativa treated effectively with metformin. Clin Exp Dermatol 2009; 34:920.
  22. Verdolini R, Clayton N, Smith A, et al. Metformin for the treatment of hidradenitis suppurativa: a little help along the way. J Eur Acad Dermatol Venereol 2013; 27:1101.
  23. Thomas CL, Gordon KD, Mortimer PS. Rapid resolution of hidradenitis suppurativa after bariatric surgical intervention. Clin Exp Dermatol 2014; 39:315.
  24. Javorsky E, Kimball AB. Hidradenitis suppurativa: patient experiences with bariatric surgery. Abstract, American Academy of Dematology Annual Meeting, Denver, Colorado, March 2014.
  25. Cordain L, Lindeberg S, Hurtado M, et al. Acne vulgaris: a disease of Western civilization. Arch Dermatol 2002; 138:1584.
  26. Melnik BC. Evidence for acne-promoting effects of milk and other insulinotropic dairy products. Nestle Nutr Workshop Ser Pediatr Program 2011; 67:131.
  27. Di Landro A, Cazzaniga S, Parazzini F, et al. Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults. J Am Acad Dermatol 2012; 67:1129.
  28. Melnik BC, John SM, Schmitz G. Over-stimulation of insulin/IGF-1 signaling by western diet may promote diseases of civilization: lessons learnt from laron syndrome. Nutr Metab (Lond) 2011; 8:41.
  29. Clemmensen OJ. Topical treatment of hidradenitis suppurativa with clindamycin. Int J Dermatol 1983; 22:325.
  30. Boer J, Jemec GB. Resorcinol peels as a possible self-treatment of painful nodules in hidradenitis suppurativa. Clin Exp Dermatol 2010; 35:36.
  31. Danby FW, Jemec GB, Marsch WCh, von Laffert M. Preliminary findings suggest hidradenitis suppurativa may be due to defective follicular support. Br J Dermatol 2013; 168:1034.
  32. Revuz J. Hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2009; 23:985.
  33. Nazary M, van der Zee HH, Prens EP, et al. Pathogenesis and pharmacotherapy of Hidradenitis suppurativa. Eur J Pharmacol 2011; 672:1.
  34. Harrison BJ, Mudge M, Hughes LE. Recurrence after surgical treatment of hidradenitis suppurativa. Br Med J (Clin Res Ed) 1987; 294:487.
  35. Jemec GB, Wendelboe P. Topical clindamycin versus systemic tetracycline in the treatment of hidradenitis suppurativa. J Am Acad Dermatol 1998; 39:971.
  36. Gener G, Canoui-Poitrine F, Revuz JE, et al. Combination therapy with clindamycin and rifampicin for hidradenitis suppurativa: a series of 116 consecutive patients. Dermatology 2009; 219:148.
  37. van der Zee HH, Boer J, Prens EP, Jemec GB. The effect of combined treatment with oral clindamycin and oral rifampicin in patients with hidradenitis suppurativa. Dermatology 2009; 219:143.
  38. Mendonça CO, Griffiths CE. Clindamycin and rifampicin combination therapy for hidradenitis suppurativa. Br J Dermatol 2006; 154:977.
  39. Yazdanyar S, Boer J, Ingvarsson G, et al. Dapsone therapy for hidradenitis suppurativa: a series of 24 patients. Dermatology 2011; 222:342.
  40. Kaur MR, Lewis HM. Hidradenitis suppurativa treated with dapsone: A case series of five patients. J Dermatolog Treat 2006; 17:211.
  41. Lorenz M, Wozel G, Schmitt J. Hypersensitivity reactions to dapsone: a systematic review. Acta Derm Venereol 2012; 92:194.
  42. Join-Lambert O, Coignard H, Jais JP, et al. Efficacy of rifampin-moxifloxacin-metronidazole combination therapy in hidradenitis suppurativa. Dermatology 2011; 222:49.
  43. Kraft JN, Searles GE. Hidradenitis suppurativa in 64 female patients: retrospective study comparing oral antibiotics and antiandrogen therapy. J Cutan Med Surg 2007; 11:125.
  44. Mortimer PS, Dawber RP, Gales MA, Moore RA. A double-blind controlled cross-over trial of cyproterone acetate in females with hidradenitis suppurativa. Br J Dermatol 1986; 115:263.
  45. Sawers RS, Randall VA, Ebling FJ. Control of hidradenitis suppurativa in women using combined antiandrogen (cyproterone acetate) and oestrogen therapy. Br J Dermatol 1986; 115:269.
  46. Joseph MA, Jayaseelan E, Ganapathi B, Stephen J. Hidradenitis suppurativa treated with finasteride. J Dermatolog Treat 2005; 16:75.
  47. Farrell AM, Randall VA, Vafaee T, Dawber RP. Finasteride as a therapy for hidradenitis suppurativa. Br J Dermatol 1999; 141:1138.
  48. Randhawa HK, Hamilton J, Pope E. Finasteride for the treatment of hidradenitis suppurativa in children and adolescents. JAMA Dermatol 2013; 149:732.
  49. Gniadecki R, Jemec GB. Lipid raft-enriched stem cell-like keratinocytes in the epidermis, hair follicles and sinus tracts in hidradenitis suppurativa. Exp Dermatol 2004; 13:361.
  50. Ellis LZ. Hidradenitis suppurativa: surgical and other management techniques. Dermatol Surg 2012; 38:517.
  51. Shuja F, Chan CS, Rosen T. Biologic drugs for the treatment of hidradenitis suppurativa: an evidence-based review. Dermatol Clin 2010; 28:511.
  52. Rambhatla PV, Lim HW, Hamzavi I. A systematic review of treatments for hidradenitis suppurativa. Arch Dermatol 2012; 148:439.
  53. Blok JL, van Hattem S, Jonkman MF, Horváth B. Systemic therapy with immunosuppressive agents and retinoids in hidradenitis suppurativa: a systematic review. Br J Dermatol 2013; 168:243.
  54. van Rappard DC, Leenarts MF, Meijerink-van 't Oost L, Mekkes JR. Comparing treatment outcome of infliximab and adalimumab in patients with severe hidradenitis suppurativa. J Dermatolog Treat 2012; 23:284.
  55. Grant A, Gonzalez T, Montgomery MO, et al. Infliximab therapy for patients with moderate to severe hidradenitis suppurativa: a randomized, double-blind, placebo-controlled crossover trial. J Am Acad Dermatol 2010; 62:205.
  56. Lesage C, Adnot-Desanlis L, Perceau G, et al. Efficacy and tolerance of prolonged infliximab treatment of moderate-to-severe forms of hidradenitis suppurativa. Eur J Dermatol 2012; 22:640.
  57. Delage M, Samimi M, Atlan M, et al. Efficacy of infliximab for hidradenitis suppurativa: assessment of clinical and biological inflammatory markers. Acta Derm Venereol 2011; 91:169.
  58. Kimball AB, Kerdel F, Adams D, et al. Adalimumab for the treatment of moderate to severe Hidradenitis suppurativa: a parallel randomized trial. Ann Intern Med 2012; 157:846.
  59. Miller I, Lynggaard CD, Lophaven S, et al. A double-blind placebo-controlled randomized trial of adalimumab in the treatment of hidradenitis suppurativa. Br J Dermatol 2011; 165:391.
  60. Adams DR, Yankura JA, Fogelberg AC, Anderson BE. Treatment of hidradenitis suppurativa with etanercept injection. Arch Dermatol 2010; 146:501.
  61. Pelekanou A, Kanni T, Savva A, et al. Long-term efficacy of etanercept in hidradenitis suppurativa: results from an open-label phase II prospective trial. Exp Dermatol 2010; 19:538.
  62. Pellegrino M, Taddeucci P, Peccianti C, et al. Etanercept induced hidradenitis suppurativa. G Ital Dermatol Venereol 2011; 146:503.
  63. Lee RA, Dommasch E, Treat J, et al. A prospective clinical trial of open-label etanercept for the treatment of hidradenitis suppurativa. J Am Acad Dermatol 2009; 60:565.
  64. Giamarellos-Bourboulis EJ, Pelekanou E, Antonopoulou A, et al. An open-label phase II study of the safety and efficacy of etanercept for the therapy of hidradenitis suppurativa. Br J Dermatol 2008; 158:567.
  65. Cusack C, Buckley C. Etanercept: effective in the management of hidradenitis suppurativa. Br J Dermatol 2006; 154:726.
  66. Mekkes JR, Bos JD. Long-term efficacy of a single course of infliximab in hidradenitis suppurativa. Br J Dermatol 2008; 158:370.
  67. Blanco R, Martínez-Taboada VM, Villa I, et al. Long-term successful adalimumab therapy in severe hidradenitis suppurativa. Arch Dermatol 2009; 145:580.
  68. Jacob SE, Kerdel SA. Biologics for hidradenitis suppurativa (Verneuil's disease in the Era of biologics). In: Hidradenitis suppurativa, 1st ed, Jemec GBE, Revuz J, Leyden J (Eds), Springer, Berlin 2006. p.145.
  69. Boer J, Nazary M. Long-term results of acitretin therapy for hidradenitis suppurativa. Is acne inversa also a misnomer? Br J Dermatol 2011; 164:170.
  70. Hogan DJ, Light MJ. Successful treatment of hidradenitis suppurativa with acitretin. J Am Acad Dermatol 1988; 19:355.
  71. Soria A, Canoui-Poitrine F, Wolkenstein P, et al. Absence of efficacy of oral isotretinoin in hidradenitis suppurativa: a retrospective study based on patients' outcome assessment. Dermatology 2009; 218:134.
  72. Dicken CH, Powell ST, Spear KL. Evaluation of isotretinoin treatment of hidradenitis suppurativa. J Am Acad Dermatol 1984; 11:500.
  73. Norris JF, Cunliffe WJ. Failure of treatment of familial widespread hidradenitis suppurativa with isotretinoin. Clin Exp Dermatol 1986; 11:579.
  74. Boer J, van Gemert MJ. Long-term results of isotretinoin in the treatment of 68 patients with hidradenitis suppurativa. J Am Acad Dermatol 1999; 40:73.
  75. Danby FW. Night blindness, vitamin A deficiency, and isotretinoin psychotoxicity. Dermatol Online J 2003; 9:30.
  76. Gupta AK, Ellis CN, Nickoloff BJ, et al. Oral cyclosporine in the treatment of inflammatory and noninflammatory dermatoses. A clinical and immunopathologic analysis. Arch Dermatol 1990; 126:339.
  77. Buckley DA, Rogers S. Cyclosporin-responsive hidradenitis suppurativa. J R Soc Med 1995; 88:289P.
  78. Rose RF, Goodfield MJ, Clark SM. Treatment of recalcitrant hidradenitis suppurativa with oral ciclosporin. Clin Exp Dermatol 2006; 31:154.
  79. Sharon VR, Garcia MS, Bagheri S, et al. Management of recalcitrant hidradenitis suppurativa with ustekinumab. Acta Derm Venereol 2012; 92:320.
  80. Gulliver WP, Jemec GB, Baker KA. Experience with ustekinumab for the treatment of moderate to severe hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2012; 26:911.
  81. Zarchi K, Dufour DN, Jemec GB. Successful treatment of severe hidradenitis suppurativa with anakinra. JAMA Dermatol 2013; 149:1192.
  82. Leslie KS, Tripathi SV, Nguyen TV, et al. An open-label study of anakinra for the treatment of moderate to severe hidradenitis suppurativa. J Am Acad Dermatol 2014; 70:243.
  83. van der Zee HH, Prens EP. Failure of anti-interleukin-1 therapy in severe hidradenitis suppurativa: a case report. Dermatology 2013; 226:97.
  84. Ducroux E, Ocampo MA, Kanitakis J, et al. Hidradenitis suppurativa after renal transplantation: Complete remission after switching from oral cyclosporine to oral tacrolimus. J Am Acad Dermatol 2014; 71:e210.
  85. van der Zee HH, Prens EP, Boer J. Deroofing: a tissue-saving surgical technique for the treatment of mild to moderate hidradenitis suppurativa lesions. J Am Acad Dermatol 2010; 63:475.
  86. Danby FW. Commentary: unroofing for hidradenitis suppurativa, why and how. J Am Acad Dermatol 2010; 63:481.e1.
  87. Lapins J, Emtestam L. Surgery. In: Hidradenitis suppurativa, 1st ed, Jemec GBE, Revuz J, Leyden J (Eds), Springer, Berlin 2006. p.160.
  88. Jemec GBE, Revuz J. Treatment. In: Hidradenitis Suppurativa, 1st ed, Jemec GBE, Revuz J, Leyden J (Eds), Springer, Berlin 2006. p.183.
  89. Finley EM, Ratz JL. Treatment of hidradenitis suppurativa with carbon dioxide laser excision and second-intention healing. J Am Acad Dermatol 1996; 34:465.
  90. Hazen PG, Hazen BP. Hidradenitis suppurativa: successful treatment using carbon dioxide laser excision and marsupialization. Dermatol Surg 2010; 36:208.
  91. Rubin RJ, Chinn BT. Perianal hidradenitis suppurativa. Surg Clin North Am 1994; 74:1317.
  92. Watson JD. Hidradenitis suppurativa--a clinical review. Br J Plast Surg 1985; 38:567.
  93. Ritz JP, Runkel N, Haier J, Buhr HJ. Extent of surgery and recurrence rate of hidradenitis suppurativa. Int J Colorectal Dis 1998; 13:164.
  94. Ramasastry SS, Conklin WT, Granick MS, Futrell JW. Surgical management of massive perianal hidradenitis suppurativa. Ann Plast Surg 1985; 15:218.
  95. Hughes LE, Harrison BJ, Mudge M. Surgical management of hidradenitis-principles and results. In: Acne and related disorders, Marks R, Plewig G (Eds), Dunitz, London 1989. p.367.
  96. Menderes A, Sunay O, Vayvada H, Yilmaz M. Surgical management of hidradenitis suppurativa. Int J Med Sci 2010; 7:240.
  97. Nesmith RB, Merkel KL, Mast BA. Radical surgical resection combined with lymphadenectomy-directed antimicrobial therapy yielding cure of severe axillary hidradenitis. Ann Plast Surg 2013; 70:538.
  98. Brocard A, Knol AC, Khammari A, Dréno B. Hidradenitis suppurativa and zinc: a new therapeutic approach. A pilot study. Dermatology 2007; 214:325.
  99. Dréno B, Khammari A, Brocard A, et al. Hidradenitis suppurativa: the role of deficient cutaneous innate immunity. Arch Dermatol 2012; 148:182.
  100. Tierney E, Mahmoud BH, Hexsel C, et al. Randomized control trial for the treatment of hidradenitis suppurativa with a neodymium-doped yttrium aluminium garnet laser. Dermatol Surg 2009; 35:1188.
  101. Xu LY, Wright DR, Mahmoud BH, et al. Histopathologic study of hidradenitis suppurativa following long-pulsed 1064-nm Nd:YAG laser treatment. Arch Dermatol 2011; 147:21.
  102. Highton L, Chan WY, Khwaja N, Laitung JK. Treatment of hidradenitis suppurativa with intense pulsed light: a prospective study. Plast Reconstr Surg 2011; 128:459.
  103. Gold M, Bridges TM, Bradshaw VL, Boring M. ALA-PDT and blue light therapy for hidradenitis suppurativa. J Drugs Dermatol 2004; 3:S32.
  104. Strauss RM, Pollock B, Stables GI, et al. Photodynamic therapy using aminolaevulinic acid does not lead to clinical improvement in hidradenitis suppurativa. Br J Dermatol 2005; 152:803.
  105. Guglielmetti A, Bedoya J, Acuna M, et al. Successful aminolevulinic acid photodynamic therapy for recalcitrant severe hidradenitis suppurativa. Photodermatol Photoimmunol Photomed 2010; 26:110.
  106. Schweiger ES, Riddle CC, Aires DJ. Treatment of hidradenitis suppurativa by photodynamic therapy with aminolevulinic acid: preliminary results. J Drugs Dermatol 2011; 10:381.
  107. Fadel MA, Tawfik AA. New topical photodynamic therapy for treatment of hidradenitis suppurativa using methylene blue niosomal gel: a single-blind, randomized, comparative study. Clin Exp Dermatol 2014.
  108. Rodríguez-Prieto MÁ, Valladares-Narganes LM, González-Sixto B, Noguerol-Cal M. Efficacy of intralesional photodynamic therapy for the treatment of hidradenitis suppurativa. J Am Acad Dermatol 2013; 68:873.
  109. Fröhlich D, Baaske D, Glatzel M. [Radiotherapy of hidradenitis suppurativa--still valid today?]. Strahlenther Onkol 2000; 176:286.
  110. Trombetta M, Werts ED, Parda D. The role of radiotherapy in the treatment of hidradenitis suppurativa: case report and review of the literature. Dermatol Online J 2010; 16:16.
  111. Feito-Rodríguez M, Sendagorta-Cudós E, Herranz-Pinto P, de Lucas-Laguna R. Prepubertal hidradenitis suppurativa successfully treated with botulinum toxin A. Dermatol Surg 2009; 35:1300.
  112. O'Reilly DJ, Pleat JM, Richards AM. Treatment of hidradenitis suppurativa with botulinum toxin A. Plast Reconstr Surg 2005; 116:1575.
  113. Deckers IE, van der Zee HH, Balak DM, Prens EP. Fumarates, a new treatment option for therapy resistant hidradenitis suppurativa: a prospective open-label pilot study. Br J Dermatol 2014.
  114. Pagliarello C, Fabrizi G, Feliciani C, Di Nuzzo S. Cryoinsufflation for Hurley stage II hidradenitis suppurativa: a useful treatment option when systemic therapies should be avoided. JAMA Dermatol 2014; 150:765.
  115. Williams ST, Busby RC, DeMuth RJ, Nelson H. Perineal hidradenitis suppurativa: presentation of two unusual complications and a review. Ann Plast Surg 1991; 26:456.
  116. Grewal NS, Wan DC, Roostaeian J, Rubayi SR. Marjolin ulcer in hidradenitis suppurativa: case reports. Ann Plast Surg 2010; 64:315.
  117. Lavogiez C, Delaporte E, Darras-Vercambre S, et al. Clinicopathological study of 13 cases of squamous cell carcinoma complicating hidradenitis suppurativa. Dermatology 2010; 220:147.