Review Question - QID 213382

This patient is presenting with chronic inflammation and pain with a physical exam demonstrating scarring and symptoms in the axillary region suggesting a diagnosis of hidradenitis suppurativa.

Hidradenitis suppurativa is a chronic inflammatory skin condition with an unclear pathophysiology that may be related to chronic follicular occlusive disease involving the follicular portion of the folliculopilosebaceous units. Patients typically present with painful swelling in the intertriginous skin areas (such as the axilla, groin, perianal, and perineal areas) that can progress to purulence and scarring. The treatment of hidradenitis suppurativa is complex as the pathophysiology is not well understood. Overall, all patients should be advised to stop smoking, lose weight, avoid traumatizing the area, and provide gentle cleansing of the region (with products such as chlorhexidine). Some patients may benefit from topical antibiotics, oral antibiotics, and in some cases, surgery.

Figure A demonstrates inflammation, purulence, and scarring in the axillary region which could be seen in hidradenitis suppurativa.

Incorrect Answers:
Answer 1: Abscess would present with a tender and fluctuant mass that can be treated with an incision and drainage. It would not present with chronic lesions and pain in the axilla. It is important to not regularly incise and drain lesions in hidradenitis suppurativa given damage, inflammation, and scar tissue can form potentially worsening the underlying pathophysiology.

Answer 2: Bacillary angiomatosis presents with bright red, friable, exophytic nodules typically in an HIV infected patient secondary to a Bartonella henselae infection.

Answer 3: Carbuncle can be thought of as a progression of folliculitis and as a collection of boils. Drainage, irrigation, and antibiotics are typically needed as treatment.

Answer 4: Folliculitis is inflammation and infection of the hair follicle and typically presents with pus surrounding a hair follicle and an absence of pain.

Bullet Summary:
Hidradenitis suppurativa presents with painful and chronic inflammation and nodules in the intertriginous areas.