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Hidradenitis suppurativa: Pathogenesis, clinical features, and diagnosis

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


Hidradenitis suppurativa (HS, from the Greek hidros = sweat and aden = glands) is a chronic inflammatory skin condition that is also known as acne inversa and, historically, as Verneuil's disease [1,2]. Although the name "hidradenitis suppurativa" implies a suppurative disorder that primarily involves sweat glands, increasing knowledge of the pathogenesis of the condition has led to the prevailing theory that HS is a chronic follicular occlusive disease involving the follicular portion of folliculopilosebaceous units (FPSUs).

The primary sites of involvement for HS are the intertriginous skin areas of the axillary, groin, perianal, perineal, and inframammary regions, though HS can occur in any skin area that contains FPSUs. The clinical manifestations vary, ranging from recurrent inflamed nodules and abscesses to draining sinus tracts and bands of severe scar formation. The associated pain, malodor, drainage, and disfigurement that accompany HS contribute to a profound psychosocial impact of the disease on many patients [3].

Early HS lesions often mimic other disorders; misdiagnosis of HS as recurrent furunculosis or "boils" is common. Prompt recognition of the correct diagnosis is important. An early and accurate diagnosis facilitates the initiation of a treatment plan aimed at minimizing the risk of progression to disabling, end-stage disease.

The pathogenesis, clinical manifestations, and diagnosis of HS will be discussed here. Treatment is reviewed separately. (See "Hidradenitis suppurativa: Treatment".)


Estimates of the prevalence of HS have varied, ranging from less than 1 percent to 4 percent [4-8]. The first population-based incidence study of HS found an annual age- and sex-adjusted incidence of 6 per 100,000 in a county in Minnesota [9]. A subsequent, larger, population-based study that utilized data from a database of more than 48 million patients in the United States found a higher incidence (11.4 per 100,000 population) [10].

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Literature review current through: Nov 2017. | This topic last updated: Oct 24, 2017.
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