This article is dermatological atlas of the morphologic presentations of
Hidradenitis Suppurativa (HS). It includes: superficial
abscesses (
boils, furnucles,
carbuncles),
abscesses that are subcutaneous and suprafascial, pyogenic
granulomas,
cysts, painful erythematous papules and plaques,
folliculitis, open ulcerations, chronic sinuses,
fistulas, sinus tracts, scrotal and genital lyphedema, dermal
contractures,
keloids (some that are still pitted with follicular ostia),
scarring, skin tags,
fibrosis, anal fissures,
fistulas (i.e. circinate, linear, arcuate),
scarring folliculitis of the buttocks (from mild to cigarette-like
scarring), condyloma like lesions in intertrigous areas, fishmouth
scars,
acne inversa, honey-comb
scarring, cribiform
scarring, tombstone comedones, and
morphia-like plaques. HS can co-exist with other follicular diseases such as
pilonidal cysts, dissecting
cellulitis,
acne conglobata,
pyoderma gangrenosum, and
acanthosis nigricans. In sum, the variety of presentations of HS as shown by these images supports the supposition that HS is a reaction pattern.HS is a follicular based diseased and its manifestations involve a multitude of follicular pathologies [1,2]. It is also known as
acne inversa (AI) because of one manifestation that involves the formation of open comedones on areas besides the face. It is as yet unclear why HS is so protean in its manifestations. HS severity is assessed using the Hurley Staging System (Table 1). It also remains unclear why hidradentitis may remain limited to Hurley Stage 1, evolve to the more confluent (Hurley Stage 2), or progress even further to the fully confluent (Hurley Stage 3).In addition, HS can be associated with other follicular based diseases such as
pilonidal cysts (PCs) of the sacrum and buttocks, dissecting
cellulitis (DC), and
acne conglobata (AC), which usually involves the face, chest, When HS occurs with PCs, DC, and/or AC it is referred to as the follicular occlusion triad or tetrad [2]. HS can more rarely be associated with
pyoderma gagrenosum (PG) or
Crohn disease (CD), other inflammatory diseases of the skin that are not follicular. The reason for this is unclear [2]. What AC, DC, HS, CD, and PG share is that they occur in bacterially rich environments. HS probably occurs with
acanthosis nigricans because many HS patients are obese [2]. This concurrence seems under reported.