Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Operative Techniques for Hidradenitis Suppurativa

History of Surgery in Hidradenitis Suppurativa Hidradenitis suppurativa (HS) was first described by two surgeons in the 1800s, Velpeau and Verneuil. There was much debate surrounding whether HS was primarily a venereal disease, tumor, or abscess. In the 1890s, Barthelemy suggested HS was a folliculitis that led to increased dermatologic interest in HS as a skin disease. For the next 60 years, treatment was largely targeted…

Office-Based Non-Excision Procedures

Introduction In the last few decades, surgical interventions for hidradenitis suppurativa (HS) have expanded well beyond traditional excisional approaches with the popularization of deroofing, the use of electrosurgical and laser-based excisions, and combined approaches that take both medical and surgical management into account. Equally important has been the motivation to move some procedures out of operating rooms with general anesthesia and into a clinic-based approach that…

Quality of Life

Introduction Hidradenitis suppurativa (HS) is characterized by relapsing, painful, suppurating, bleeding nodules, abscesses, and sinus tracts that primarily affect intertriginous skin. Aside from its debilitating physical manifestations, the disease carries a profound psychological burden and socioeconomic impact. These factors contribute to a significantly impaired quality of life (QoL) for patients with HS. In this chapter, we will cover a broad range of factors that impact QoL…

Dressings and Wound Care Supplies for Hidradenitis Suppurativa

Introduction to Wound Care in Hidradenitis Suppurativa The most important step in managing hidradenitis suppurativa (HS)-related wounds is to treat the underlying disease with appropriate medical and surgical approaches. Even so, proper local wound care is a key cornerstone of management for patients with HS, especially in those with advanced disease. Clinicians will encounter two types of wounds: typical or lesional HS wounds, and post-surgical wounds.…

Pain and Itch Control

Introduction Pain is the most burdensome symptom of hidradenitis suppurativa (HS), accounting for greater impairment in HS-related quality of life (QoL) than even disease severity. Although it has received relatively less attention, pruritus is also common in HS and contributes to disability and poor health-related QoL among those living with HS. This chapter summarizes what is currently known about the epidemiology, clinical characteristics, and pathophysiology of…

Targeted Therapeutics: Biologics, Small Molecules

Introduction Hidradenitis suppurativa (HS) is a chronic inflammatory disorder with a complex, multifactorial, and incompletely elucidated pathophysiology. Among relevant host factors are a number of important inflammatory pathways, including increased production of oxygen free radicals, enhanced expression of toll-like receptors and release of pro-inflammatory cytokines, increased tumor necrosis factor (TNF)-α expression, activation of the interleukin-23 (IL-23)/T helper-17 (TH-17) pathway, overproduction of interleukin-1 (IL-1), and others (…

Non-Antibiotic and Non-Biologic Systemic Therapeutics

Introduction The pathogenesis of hidradenitis suppurativa (HS) remains to be fully elucidated. Genetic susceptibility along with hormonal fluctuations and immune dysregulation are all thought to contribute to HS development. HS tends to occur in patients with comorbid conditions associated with hyperandrogenism, insulin resistance, and inflammation including acne vulgaris, hirsutism, diabetes, and polycystic ovary syndrome (PCOS). Utilizing multimodal treatment regimens including hormonal therapies (anti-androgens, anti-diabetics), systemic immunomodulators…

Systemic Antibiotics in Hidradenitis Suppurativa

Introduction Antibiotics alone, or in combination with other therapeutic strategies, have been empirically used in hidradenitis suppurativa (HS) with variable success, resulting only in temporary symptom relief in the disease process. Although very few randomized controlled studies have been performed to confirm their efficacy, antibiotics are currently recommended worldwide as first-line therapy by several guidelines issued from scientific dermatological societies. Rationale for the Use of Antibiotics…

Topical Therapeutics

Introduction Topical therapy is a mainstay of dermatological treatment and holds many advantages, including ease of use, relative lack of systemic side effects, and patient-directed application. In hidradenitis suppurativa (HS), topical therapeutics are often used for early-stage lesions or as a complement to systemic or surgical treatments. The four categories of disease-modifying topical therapy for HS are antibiotics, antiseptics, keratolytics, and bathing additives (each of which…

Overview and Comparison of Hidradenitis Suppurativa Management Guidelines

Introduction Long considered an orphan disease until recent years, hidradenitis suppurativa (HS) is rapidly gaining attention in the healthcare field with a growing spotlight on investigating HS pathogenesis, epidemiology, and treatment options. To better navigate the expanding therapeutic options available, a number of HS management guidelines have been published by international expert organizations from North America, South America, and Europe between 2015 and July 2020 (…

Disease Evaluation and Outcome Measures

Introduction Outcome measures play an important role in the field of dermatology, both in routine clinical practice and in clinical research trials. In clinical settings, robust outcome measures serve to classify disease severity, which can direct treatment choice. Outcome measures can also assess changes in disease severity over time. Furthermore, these measures provide a common language between providers that can allow for effective communication of a…

Genetics and Epigenetics of Hidradenitis Suppurativa

Introduction Hidradenitis suppurativa (HS) is an inflammatory condition characterized by painful and sometimes purulent nodules, abscesses, and sinus tracts located in intertriginous regions. Lesions may progress to form hypertrophic scars or dermal tunnels. HS patients are regarded as having one of the worst qualities of life among the major dermatologic conditions. Comorbidities include obesity, asthma, acne, diabetes, dyslipidemia, hypertension, thyroid disease, rheumatoid arthritis, depression, psoriasis, and…

Microbiota Perturbations in Hidradenitis Suppurativa

Introduction Hidradenitis suppurativa (HS) is a disabling chronic inflammatory disease with significant comorbidities that affects an estimated 1% of the Western population. A poor understanding of HS biology has limited the development of uniformly effective treatments. The characteristic lesions of HS in conjunction with disease improvement with broad spectrum antibiotic therapy have implicated bacteria in HS pathogenesis and suggested novel areas for consideration of therapeutic development.…

Follicular Occlusion and Inflammation

Introduction The pathogenic model of hidradenitis suppurativa (HS) may be in the midst of a paradigm shift, balancing the initial model of a disorder of (primary) follicular occlusion with consideration as an autoinflammatory keratinization disease (AiKD). There is observational, experimental, and therapeutic evidence to support the concept of HS as a primarily inflammatory disorder and/or a disorder of autoimmunity (in contrast to that primarily of follicular…

Disease Complications

Introduction Over time, repeated episodes of hidradenitis suppurativa (HS) disease flares can lead to a number of debilitating cutaneous, systemic, as well as psychological and social complications. Given the progressive course of this disease, early diagnosis and initiation of appropriate treatment is critical to limiting the development of serious complications. Cutaneous Complications The typical skin lesions associated with HS include tender subcutaneous nodules and sterile abscesses;…

Comorbidities and Systemic Associations

Introduction HS represents a prime candidate to bridge diseases of the integument and comorbid systemic disease, as a chronic inflammatory disease of the pilosebaceous unit characterized by inflammatory nodules, suppuration and abscess formation resulting in pain and disfigurement. In addition to its locally destructive course, HS has gained recognition for its association with individual comorbid diseases as well as all-cause mortality. Indeed, patients with HS have…

Clinical Evaluation

Overview of Patient Population with HS Prior to Initiating Therapy Hidradenitis suppurativa is a clinical diagnosis based on history, physical exams, patterns of recurrence, types of lesions, and scarring. No diagnostic test is currently available and biopsy results are relatively non-specific compared to clinical patterns. Once the diagnosis has been made, an assessment of severity and comorbidities should follow, as they will affect treatment choices. Obtaining…

Imaging Techniques in Hidradenitis Suppurativa and Comorbidities

Introduction The imaging support of hidradenitis suppurativa (HS) has been increasing in the last decade due to the development of high-axial-resolution devices that can detect simultaneously and with high definition abnormalities of the skin and deeper layers. Nowadays, the spatial axial resolution, which allows the discrimination of two adjacent reflector points, is much higher on ultrasound than MRI or CT. It should be kept in mind…

Histopathology of the Pilosebaceous Unit and Interstitium of Hidradenitis Suppurativa

Introduction It is useful to consider the histological findings of hidradenitis suppurativa (HS) lesions in the context of populations at risk for HS to understand the clinical differences observed amongst these populations. HS disproportionately affects women, persons 18 to 29 years of age, and African Americans (AA). Women are more likely to have axillary and upper anterior torso involvement, while male HS patients are more likely…

Hidradenitis Suppurativa Differential Diagnosis and Mimickers

Introduction The average length of time from onset to diagnosis in hidradenitis suppurativa (HS) patients worldwide is 7.2 years. This unfortunate delay is partly because of the nonspecific nature of many HS lesions—inflammatory papules, nodules, pustules, abscesses, and scarring—which may be confused with a variety of other cutaneous diseases. The diagnosis may also be confounded by coexistence or overlap with other inflammatory diseases presenting with similar…