Exp Dermatol 2006 Jun; 15(6): 478 (Read article online)

Zouboulis CC

Hidradenitis suppurativa (HS)/acne inversa (AI) is a chronic, recurrent, debilitating skin disease that presents with painful, inflamed lesions in the apocrine gland-bearing areas of the body, most commonly the axillary, inguinal, and anogenital areas. The disorder is associated with several clinical disputes, such as the discussion on the exact skin appendage involved, namely the sweat glands, the apocrine glands or the terminal hair follicles, and the discussion on the pathogenetic background, namely a genetic, hormonal, bacterial, genuine inflammatory, environmental, or physical one. The significance of gender, body mass, and smoking on disease prevalence is still under investigation. Moreover, the major challenge is the choice of the optimal treatment: antibiotics, retinoids, corticosteroids, incision and drainage, local wound care, limited or radical local excision, radiation, laser therapy, and modern drugs, such as biologics, have been proposed. The psychological impact on the patient can be great, encompassing social, personal, and occupational challenges. The sequelae of the disease, including dermal contraction, keloid formation, restricted limb mobility, lymphedema, and fistula formation dominate the long-term burden associated with patient's quality of life. Significant research is required to elucidate the etiology of HS/AI, classify the clinical picture, identify appropriate drug candidates, and evaluate the social, economic, and psychological impact of the disease.