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Hidradenitis suppurativa is a chronic inflammatory skin condition characterized by recurrent follicular inflammation, typically in the intertriginous areas. Manifestations include painful skin lesions (nodules and abscesses), draining sinus tracts, and scarring; the severity of symptoms varies. The disease typically affects young adults. The exact etiology is unknown but likely multifactorial and thought to involve blockage of hair follicles. Diagnosis is clinical and treatment includes wound care, pain management, and pharmacotherapy. Psychological support may be required for mental health conditions that can be associated with hidradenitis suppurativa. Surgical interventions may be needed for severe and/or recurrent disease. Complications include disfigurement resulting from excessive scarring, bacterial superinfection, and, in affected areas, cutaneous squamous cell carcinoma.
The exact etiology of hidradenitis suppurativa is unknown, but the following factors may contribute to the development and/or severity of the disease: 
- Genetic predisposition to:
- Hormonal imbalances
- Environmental factors
- Localized in intertriginous areas containing apocrine glands (most commonly the axillae, groin, inner thigh, perineal and perianal areas)
- The first lesion is usually a solitary painful inflammatory nodule that progresses to an abscess that may open or regress spontaneously.
- Sinus tracts may form between multiple recurrent nodules and drain foul-smelling, seropurulent discharge.
- Development of open ; and closed comedones
- Scarring ranges from small, individual acneiform scars to thick scarred plaques that affect larger areas of skin.
Diagnosis is clinical, based on both of the following. 
- Clinical features of hidradenitis suppurativa, including:
- Exclusion of differential diagnoses for hidradenitis suppurativa; studies may include:
General principles 
Hidradenitis suppurativa is a chronic condition with no cure and requires.
- Provide supportive care, including pain management.
- Screen for and manage hidradenitis suppurativa-associated comorbidities.
- Initiate first-line pharmacological therapies, which may include:
- Topical or intralesional therapies
- Systemic therapies (e.g., oral antibiotics, hormonal therapy)
- Refer patients with moderate, severe, or refractory disease to dermatology for management. 
Supportive care 
- Patient education on disease process and management
- Recommend smoking cessation if relevant. 
- Warm compresses
- Cover open wounds.
- Discuss ways to improve physical comfort, e.g., wearing loose-fitting clothes.
- Pain management
Hidradenitis suppurativa-associated comorbidities 
Screen for and manage the following conditions that commonly co-occur with hidradenitis suppurativa:
- Metabolic syndrome and its components
- Polycystic ovarian syndrome
- Immune-mediated conditions
- Inflammatory bowel disease
- Inflammatory arthropathies
- Mental health conditions
- Sexual dysfunction
- Squamous cell carcinoma: may occur in areas affected by hidradenitis suppurativa, especially on the perineum and buttocks
Recommend weight reduction to patients with obesity, as it may improve the severity of disease. 
Pain, malodorous drainage, and scarring often negatively impact the patient's quality of life. 
Pharmacological therapy 
Treatment may include different combinations of the following, depending on the severity of disease:
- Topical antibiotics: e.g., clindamycin, dapsone
- Topical resorcinol
- Intralesional triamcinolone
- Antiseptic washes: e.g., chlorhexidine, benzoyl peroxide, zinc pyrithione
- Oral antibiotics: e.g., tetracyclines, clindamycin PLUS rifampin, dapsone
- Hormonal therapies: e.g., spironolactone, combined oral contraceptives, metformin 
- Oral retinoids (limited efficacy): e.g., acitretin, isotretinoin 
- Oral biologics: e.g., (adalimumab or infliximab), anakinra
- Immunosuppressants 
Procedural interventions 
For lesions refractory to pharmacological therapy, any of the following may be performed:
- Chronic with a high rate of recurrence 
- Decreases quality of life