Clinical Review

Diagnosis and management of hidradenitis suppurativa

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2121 (Published 23 April 2013) Cite this as: BMJ 2013;346:f2121
  1. Fiona Collier, general practitioner with special interest in dermatology1,
  2. Robert C Smith, consultant surgeon2,
  3. Colin A Morton, consultant dermatologist3
  1. 1Dermatology Department, Stirling Community Hospital, Stirling, UK
  2. 2Department of Surgery, Forth Valley Royal Hospital, Larbert, UK
  3. 3Department of Dermatology, Forth Valley Royal Hospital
  1. Correspondence to: F Collier, Alva Medical Practice, Alva, FK12 5BD, UK fiona.collier{at}nhs.net
  • Accepted 18 March 2013

Summary points

  • Hidradenitis suppurativa is a chronic condition that presents as persistent or recurrent boils in the groin, axillae, and other apocrine bearing sites

  • Disease progresses to scarring and sinus formation in some cases

  • Mild cases are best managed by trying to reduce risk factors and tailored medical management

  • More severe cases require liaison between dermatologist, general practitioner, and surgeon for optimal treatment

  • Repeated simple incision and drainage rarely result in resolution of lesions and should not be the only treatment

Most health professionals who regularly examine adult patients will have seen hidradenitis suppurativa. The characteristic scarring of the axillae, inguinal areas, and breasts can be seen on routine physical examination, but the diagnosis may go unrecognised. The prevalence of this condition is around 1% in many European populations, and management is commonly shared between general practice, dermatology, and various surgical specialties.1 2 Validated quality of life tools show worse scores for pain, effects on social functioning, living activities, and self image in hidradenitis than in psoriasis and eczema.3 4

This review aims to provide guidance for the management of hidradenitis in primary care, suggestions for when referral to secondary care is appropriate, and an overview of the available medical and surgical interventions.

Sources and selection criteria

We searched Embase, Medline, and CINAH using keywords “hidradenitis”, “hidradenitis suppurative”, “suppurativa hidradenitis”, “hidradenitis suppurativa, familial”, and “acne inversa” for original research and reviews from 2005 to September 2012. We also manually searched studies cited in reviews. The NHS Evidence into Practice resource and the Cochrane Controlled Trials Register were also searched. We checked the bibliography of Jemec and colleagues’ 2006 book Hidradenitis suppurativa for additional sources,1 in addition to the website of the British Association for Hidradenitis Suppurativa. The literature consists mostly of open studies and clinical reports on small groups of patients, with few …

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