Hidradenitis suppurativa: The Daily PANCE Blueprint
A 29-year-old female smoker presents with recurrent painful nodules and draining abscesses in her axillae. Physical exam reveals deep nodules and scarring. Which of the following is the most likely diagnosis?
A. Acne vulgaris
B. Folliculitis barbae
C. Cellulitis
D. Hidradenitis suppurativa
E. Epidermal inclusion cysts
Answer and topic summary
The answer is D. Hidradenitis suppurativa
Hidradenitis suppurativa is a chronic folliculitis that impacts intertriginous areas (e.g., axillary, groin, perianal, perineal, etc.). It typically occurs in adults (18 to 40-year-olds). It is associated with diabetes and Crohn’s disease. Risk factors include obesity, smoking, and a family history. On physical exam, you should expect to see painful, deep nodules, abscesses with purulent drainage, open double “tombstone” comedones, scarring, and even fissures. Treatment includes topical antibiotics (e.g., clindamycin), oral antibiotics for more moderate to severe disease, and biologics such as adalimumab (Humira). Surgery can be considered for those with lots of scarring. Weight loss and smoking cessation should be stressed.
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