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Hidradenitis suppurativa
Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the hair follicle in body folds — axillae, groins, buttocks and under the breasts — with painful nodules, recurrent abscesses, tunnels (sinus tracts) and scars; it is not a simple infection and is not caused by poor hygiene.
Why it matters in the exam
The exam shows a young overweight woman who smokes and has "recurrent abscesses in the axilla" drained several times, and asks for the diagnosis, the Hurley stage and the treatment. Also asked are complications (SCC in long-standing buttock disease, anaemia, amyloidosis, depression), the link to Crohn disease and metabolic syndrome, and biologic treatment — adalimumab, secukinumab and bimekizumab — for moderate to severe disease. Remember that repeated drainage of abscesses does not solve the problem, and that for chronic tunnels deroofing or wide excision is better. Another key point: the diagnosis is clinical and based on three components — typical lesions, typical sites and recurrence — and culture is not needed to make it. Stopping smoking and losing weight are part of treatment at every stage. The disease usually starts after puberty, is more common in women, and can severely affect quality of life, work and sexual life. In the exam remember that the answer "drainage and a week of antibiotics" is usually the distractor, and that the right answer includes long-term treatment, staging and management of risk factors.
Key points
- HS is a chronic inflammatory follicular disease of the folds, with painful nodules, recurrent abscesses, tunnels and scars.
- The diagnosis is clinical and based on typical lesions, sites in the folds and recurrence.
- The Hurley stage sets the approach: topical treatment in stage I, systemic antibiotics in between, and biologics with surgery in severe disease.
- Adalimumab, secukinumab and bimekizumab are approved for moderate to severe disease.
- Stopping smoking, losing weight and excluding SCC in chronic lesions are part of treatment.
Summary table
| Hurley stage | Findings | Medical treatment | Surgical treatment |
|---|---|---|---|
| Stage I | Single nodules or abscesses, no tunnels and no scars | Topical clindamycin, oral tetracycline, intralesional steroid injection | Drainage only for relief of an acute abscess |
| Stage II | Recurrent abscesses with tunnels and scars, separate areas | Tetracycline or clindamycin with rifampicin; biologic in moderate disease | Deroofing of tunnels |
| Stage III | Diffuse involvement with interconnected tunnels and abscesses across the whole area | Adalimumab, secukinumab or bimekizumab | Wide excision of the whole affected area |
| General measures at every stage | Smoking, obesity, friction | Stop smoking, weight loss, pain management | Psychological support and screening for complications |
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Sources
- North American clinical management guidelines for hidradenitis suppurativa (US and Canadian HS Foundations), 2019 — Medical and surgical management
- European S2k guideline for hidradenitis suppurativa (EDF/EADV), 2024 — Treatment by severity
- British Association of Dermatologists guidelines for the management of hidradenitis suppurativa, 2018 — Treatment
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.