🔹 What is Hidradenitis Suppurativa?
Hidradenitis Suppurativa (HS) is a chronic, inflammatory skin disease that affects the hair
follicles and apocrine sweat glands, primarily in areas where skin rubs together—like the
armpits, groin, buttocks, and under the breasts. It's not infectious or due to poor hygiene.
🔹 Key Characteristics:
Painful, deep-seated nodules, abscesses, and draining sinus tracts
Recurrent flare-ups and scarring
Commonly affects women more than men
Onset typically occurs in the late teens to early 30s
🔹 Clinical Staging (Hurley Staging System):
1. Stage I: Single or multiple abscesses without sinus tracts or scarring
2. Stage II: Recurrent abscesses with sinus tract formation and scarring
3. Stage III: Diffuse or near-diffuse involvement with interconnected tracts and multiple
abscesses
🔹 Risk Factors:
Obesity
Smoking
Family history
Possible association with metabolic syndrome, Crohn’s disease, and hormonal
imbalances
🔹 Treatment Options:
Topical clindamycin (mild cases)
Oral antibiotics (e.g., doxycycline or clindamycin + rifampin)
Hormonal therapy (e.g., spironolactone or OCPs in women)
Biologic agents (e.g., adalimumab – FDA approved for moderate to severe HS)
Surgical intervention for sinus tracts and scar tissue
Lifestyle changes: Weight loss, smoking cessation, hygiene with gentle cleansers
, 🔹 Patient Counseling:
HS is not contagious
Early treatment can reduce long-term scarring and improve quality of life
Emotional support and mental health screening are important—HS is associated with
depression and anxiety
Let me know if you'd like a sample H&P for an HS patient or a patient education handout!
CC:
“Painful bumps under my arms that keep coming back.”
HPI:
J.L. is a 33-year-old female presenting with recurrent, painful lumps in her bilateral axillae for
the past 2 years, worsening over the past 3 months. She reports the lesions often begin as tender
nodules, which enlarge and occasionally rupture with foul-smelling drainage. The current flare
began 1 week ago and involves multiple painful bumps on the right axilla. She denies fever or
chills but reports increasing discomfort and embarrassment due to odor and drainage. She notes a
history of similar breakouts in her groin area. Lesions tend to resolve slowly and leave behind
dark marks and occasional scarring. She has tried over-the-counter antibacterial washes with
minimal benefit. No history of boils elsewhere.
She smokes occasionally and has gained approximately 20 lbs in the last year. She is otherwise
healthy and not currently on any prescription medications.
Allergies:
NKDA
ROS:
General: Denies fever, weight loss, or fatigue
Hidradenitis Suppurativa (HS) is a chronic, inflammatory skin disease that affects the hair
follicles and apocrine sweat glands, primarily in areas where skin rubs together—like the
armpits, groin, buttocks, and under the breasts. It's not infectious or due to poor hygiene.
🔹 Key Characteristics:
Painful, deep-seated nodules, abscesses, and draining sinus tracts
Recurrent flare-ups and scarring
Commonly affects women more than men
Onset typically occurs in the late teens to early 30s
🔹 Clinical Staging (Hurley Staging System):
1. Stage I: Single or multiple abscesses without sinus tracts or scarring
2. Stage II: Recurrent abscesses with sinus tract formation and scarring
3. Stage III: Diffuse or near-diffuse involvement with interconnected tracts and multiple
abscesses
🔹 Risk Factors:
Obesity
Smoking
Family history
Possible association with metabolic syndrome, Crohn’s disease, and hormonal
imbalances
🔹 Treatment Options:
Topical clindamycin (mild cases)
Oral antibiotics (e.g., doxycycline or clindamycin + rifampin)
Hormonal therapy (e.g., spironolactone or OCPs in women)
Biologic agents (e.g., adalimumab – FDA approved for moderate to severe HS)
Surgical intervention for sinus tracts and scar tissue
Lifestyle changes: Weight loss, smoking cessation, hygiene with gentle cleansers
, 🔹 Patient Counseling:
HS is not contagious
Early treatment can reduce long-term scarring and improve quality of life
Emotional support and mental health screening are important—HS is associated with
depression and anxiety
Let me know if you'd like a sample H&P for an HS patient or a patient education handout!
CC:
“Painful bumps under my arms that keep coming back.”
HPI:
J.L. is a 33-year-old female presenting with recurrent, painful lumps in her bilateral axillae for
the past 2 years, worsening over the past 3 months. She reports the lesions often begin as tender
nodules, which enlarge and occasionally rupture with foul-smelling drainage. The current flare
began 1 week ago and involves multiple painful bumps on the right axilla. She denies fever or
chills but reports increasing discomfort and embarrassment due to odor and drainage. She notes a
history of similar breakouts in her groin area. Lesions tend to resolve slowly and leave behind
dark marks and occasional scarring. She has tried over-the-counter antibacterial washes with
minimal benefit. No history of boils elsewhere.
She smokes occasionally and has gained approximately 20 lbs in the last year. She is otherwise
healthy and not currently on any prescription medications.
Allergies:
NKDA
ROS:
General: Denies fever, weight loss, or fatigue
