{"id":8246,"date":"2022-07-19T16:56:52","date_gmt":"2022-07-19T15:56:52","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=8246"},"modified":"2025-08-18T11:34:03","modified_gmt":"2025-08-18T10:34:03","slug":"hidradentis-suppurativa","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dermatology\/hidradentis-suppurativa\/","title":{"rendered":"Hidradentis Suppurativa"},"content":{"rendered":"\n<div class=\"wp-block-media-text is-stacked-on-mobile\" style=\"grid-template-columns:23% auto\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"482\" height=\"642\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Hidradentis-suppuirativa-axilla.png\" alt=\"Hidradentis suppuirativa axilla\" class=\"wp-image-19044 size-full\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Hidradentis-suppuirativa-axilla.png 482w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Hidradentis-suppuirativa-axilla-225x300.png 225w\" sizes=\"auto, (max-width: 482px) 100vw, 482px\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<p>Axilla<\/p>\n\n\n\n<div class=\"wp-block-media-text is-stacked-on-mobile\" style=\"grid-template-columns:37% auto\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"642\" height=\"482\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Hidradentis-suppuirativa-groin.png\" alt=\"Hidradentis suppuirativa groin\" class=\"wp-image-19042 size-full\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Hidradentis-suppuirativa-groin.png 642w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Hidradentis-suppuirativa-groin-300x225.png 300w\" sizes=\"auto, (max-width: 642px) 100vw, 642px\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<p>Groin<\/p>\n\n\n\n<div class=\"wp-block-media-text is-stacked-on-mobile\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"442\" height=\"332\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Hidradentis-suppuirativa-breast-e1714042072574.png\" alt=\"Hidradentis suppuirativa breast\" class=\"wp-image-19043 size-full\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<p>Breast<\/p>\n<\/div><\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n\n\n<p><em>all images copyright <a href=\"https:\/\/dermnetnz.org\/#gsc.tab=1&amp;gsc.q=hyper%20actinic%20keratoses&amp;gsc.page=1\">DermNet (dermnetnz.org)<\/a><\/em><\/p>\n\n\n\n<p><strong>R.C 24-05-24<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li>\u200bDiagnostic&nbsp;uncertainty<\/li>\n\n\n\n<li>Not responding to Primary Care Management<\/li>\n\n\n\n<li>Moderate or Severe disease I.e. recurrent lesions separated by normal skin with sinus tract formation and scarring or multiple lesions coalescing into inflammatory plaques involving most of the affected region&nbsp;<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>Hidradenitis suppurativa (HS) &#8211; also known as acne inversa- is a disease of apocrine glands and can affect axillae, groins, perineum and inframammary areas. It is a neutrophilic inflammatory condition with hyperkeratotic follicular occlusion causing blockage and subsequent follicular rupture.<\/p>\n\n\n\n<p>&nbsp;HS can vary in severity of presentation, from scattered inflammatory nodules and pustules through to abscesses, sinus formation and scarring.<\/p>\n\n\n\n<p>Diagnosis requires lesions to be chronic and recurrent and severity can be classified using scoring systems such as the Hurley Stages.<\/p>\n\n\n\n<p>Consider HS where there are more than 2 abscesses in a flexural area in a six-month period. Early treatment is important to reduce progression to severe disease.<\/p>\n\n\n\n<p><strong>Factors associated with increased risk of HS include:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Obesity<\/li>\n\n\n\n<li>Type 2 diabetes mellitus<\/li>\n\n\n\n<li>Smoking<\/li>\n\n\n\n<li>Polycystic ovary syndrome<\/li>\n\n\n\n<li>Family history (approximately 30% of cases)<\/li>\n\n\n\n<li>Female sex (post menarche\/premenopause)<\/li>\n\n\n\n<li>Having Black or Mediterranean skin<br><\/li>\n<\/ul>\n\n\n\n<p>HS can be associated with:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Spondyloarthritis &#8211; including ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, as well as generalised joint pains<\/li>\n\n\n\n<li>Acne<\/li>\n\n\n\n<li>Increased cardiovascular risk<\/li>\n\n\n\n<li>Crohn&#8217;s Disease (especially if groin\/perianal lesions involved)<\/li>\n<\/ul>\n\n\n\n<p>&nbsp;It can also form part of 2 uncommon familial syndromes:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>PASH syndrome:&nbsp;<a href=\"https:\/\/dermnetnz.org\/topics\/pyoderma-gangrenosum\/\" target=\"_blank\" rel=\"noreferrer noopener\">pyoderma gangrenosum<\/a>, &nbsp;<a href=\"https:\/\/dermnetnz.org\/topics\/acne-and-other-follicular-disorders\/\" target=\"_blank\" rel=\"noreferrer noopener\">acne<\/a>&nbsp;and &nbsp;<a href=\"https:\/\/dermnetnz.org\/topics\/hidradenitis-suppurativa\/\" target=\"_blank\" rel=\"noreferrer noopener\">hidradenitis suppurativa<\/a>,&nbsp;<\/li>\n\n\n\n<li>PAPASH syndrome: Pyogenic arthritis,&nbsp;<a href=\"https:\/\/dermnetnz.org\/topics\/acne-and-other-follicular-disorders\/\" target=\"_blank\" rel=\"noreferrer noopener\">acne<\/a>, &nbsp;<a href=\"https:\/\/dermnetnz.org\/topics\/pyoderma-gangrenosum\/\" target=\"_blank\" rel=\"noreferrer noopener\">pyoderma gangrenosum<\/a>&nbsp;and&nbsp;<a href=\"https:\/\/dermnetnz.org\/topics\/hidradenitis-suppurativa\/\" target=\"_blank\" rel=\"noreferrer noopener\">hidradenitis suppurativa<\/a><\/li>\n<\/ul>\n\n\n\n<p><strong>General measures<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Advice and support re weight reduction<\/li>\n\n\n\n<li>Advice &amp; support re smoking cessation<\/li>\n\n\n\n<li>Advice re unfragranced antiperspirants<\/li>\n\n\n\n<li>Advice re avoiding tight clothing or wearing synthetic materials<\/li>\n\n\n\n<li>Assess impact on mental health<\/li>\n\n\n\n<li>Screen for Type 2 diabetes &amp; carry out CVD risk assessment<\/li>\n\n\n\n<li>Assess for associated spondyloarthritis\/joint pains<\/li>\n<\/ul>\n\n\n\n<p><strong>Topical treatment<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>1% clindamycin solution applied twice daily to affected areas for 12 weeks. Avoid preparations with alcohol as this can irritate the skin.<\/li>\n\n\n\n<li>Antibacterial wash to reduce skin bacterial load (e.g. Dermol 500 or 4% chlorhexidine).<\/li>\n\n\n\n<li>Appropriate absorbent, non-adherent dressings to manage pus and reduce friction.<\/li>\n<\/ul>\n\n\n\n<p><strong>Systemic treatment<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Analgesia as lesions are usually painful.<\/li>\n\n\n\n<li>Lymecycline 408mg once daily or doxycycline 100mg once daily for 12 weeks.<\/li>\n\n\n\n<li>Consider starting clindamycin 300mg and rifampicin 300mg both twice daily for 10-12 weeks if severe disease. Remember that rifampicin prevents to COCP from working, so female patients of fertile age will need to use a robust alternative method of contraception. U&amp;E and LFTs should be checked prior to starting. Maintain treatment if helps.&nbsp;Half doses of both medications may be appropriate if GI side effects are significant.<\/li>\n<\/ul>\n\n\n\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-cd0179324d70042a57ad76ab01f4c5e5\">\u00a0<em><strong>This treatment option is not available due to national shortage of rifampicin until further notice.<\/strong><\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Cyproterone acetate\/ethinyl oestradiol COCP especially if cyclical flares.<\/li>\n\n\n\n<li>Consider metformin to reduce insulin resistance.<\/li>\n\n\n\n<li>Consider intralesional triamcinolone injection for large individual lesions.<\/li>\n<\/ul>\n\n\n\n<p><strong>Secondary Care treatments include:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Acitretin or isotretinoin<\/li>\n\n\n\n<li>Dapsone<\/li>\n\n\n\n<li>Adalimumab<\/li>\n\n\n\n<li>Secukinumab<\/li>\n\n\n\n<li>Bimekizumab<\/li>\n\n\n\n<li>Infliximab<\/li>\n\n\n\n<li>Surgical incision and drainage of individual lesions or excision of more extensive areas<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>For Patients<\/strong><\/p>\n\n\n\n<p>PIL Hidradenitis suppurativa&nbsp;<a href=\"https:\/\/www.bad.org.uk\/shared\/get-file.ashx?id=88&amp;itemtype=document\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.bad.org.uk\/shared\/get-file.ashx?id=88&amp;itemtype=document<\/a><\/p>\n\n\n\n<p>There is an HS Support Group on Facebook but activity currently suspended. Can be accessed via PainUK website.<\/p>\n\n\n\n<p><strong>For Health Professionals<\/strong><\/p>\n\n\n\n<p><a href=\"https:\/\/dermnetnz.org\/topics\/hidradenitis-suppurativa-severity-assessment\">https:\/\/dermnetnz.org\/topics\/hidradenitis-suppurativa-severity-assessment<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.pcds.org.uk\/clinical-guidance\/hidradenitis-suppurativa\">https:\/\/www.pcds.org.uk\/clinical-guidance\/hidradenitis-suppurativa<\/a><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"685\" height=\"1024\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Dermatology20HS1-685x1024.jpg\" alt=\"Dermatology Hidradentis Suppurativa\" class=\"wp-image-8938\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Dermatology20HS1-685x1024.jpg 685w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Dermatology20HS1-201x300.jpg 201w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Dermatology20HS1-768x1148.jpg 768w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Dermatology20HS1-763x1140.jpg 763w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Dermatology20HS1.jpg 779w\" sizes=\"auto, (max-width: 685px) 100vw, 685px\" \/><figcaption><span class=\"media-credit\">British Association of Dermatolists<\/span><\/figcaption><\/figure>\n<\/div><\/div>\n<\/div>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>all images copyright DermNet (dermnetnz.org) R.C 24-05-24<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3853,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[708],"class_list":["post-8246","page","type-page","status-publish","hentry","category-hidradentis-suppurativa"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/dermatology\/hidradentis-suppurativa\/\" rel=\"tag\">Hidradentis Suppurativa<\/a>","rttpg_excerpt":"all images copyright DermNet (dermnetnz.org) R.C 24-05-24","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/8246","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=8246"}],"version-history":[{"count":15,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/8246\/revisions"}],"predecessor-version":[{"id":25183,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/8246\/revisions\/25183"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3853"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=8246"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=8246"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}