Hidradenitis suppurativa, a chronic relapsing disease of apocrine gland-bearing areas, most frequently occurs in the axillae, groin, perineal, and perianal regions.
Hidradenitis of vulva is frequently misdiagnosed and inadequately treated. The case of a 15-year-old nulliparous black female adolescent referred for evaluation of multiple draining
fistulas of the anogenital region is presented. Diagnostic studies for granulomatous disease were negative. Results of a barium enema were normal and biopsies were compatible with the diagnosis of
hidradenitis suppurativa. She was treated for 22 weeks with
isotretinoin, 1 mg/kg daily, with an excellent response. Side effects were minor and included
cheilitis, mild xerosis, and a transient elevation of serum
alkaline phosphatase levels. Few patients with severe
hidradenitis have been responsive to this synthetic
vitamin A derivative. A review of the literature indicates that the results of treatment with
isotretinoin for
hidradenitis have been at best equivocal.
Isotretinoin should never be used during pregnancy because of known teratogenic effects. Women of childbearing age must use effective
contraception during treatment.