Case Study: Hidradenitis suppurativa

The case A 25-year-old woman presented with a history of recurrent abscesses and pus-like discharge from her axillae. She was obese and a heavy smoker. What is the diagnosis, management and differential diagnoses?

The case

A 25-year-old woman presented with a history of recurrent abscesses and pus-like discharge from her axillae. She was obese and a heavy smoker. What is the diagnosis, management and differential diagnoses? 

Diagnosis and management

This patient has hidradenitis suppurativa, an inflammatory skin disease that occurs on apocrine sweat gland-bearing skin such as in the groin, axillae and under the breasts. Disease may spread to less commonly associated sites. Anogenital involvement most commonly affects the groin, mons pubis, vulva, sides of the scrotum, perineum, buttocks and perianal folds. The abscesses and sinus tracts can be painful and result in scarring.

It is associated with strong family history, obesity, hirsutism, acne and smoking. Women are affected three times as often as men. It occurs between 20-40 years. of age and occurs rarely before puberty and after menopause.

Treatment includes topical antiseptics and systemic antibiotics. Surgical drainage or excision may be needed in severe cases. The patient should be advised to wear loose fitting clothing.

Possible different diagnoses

  • Axillary abscess.
  • Scabetic nodule.

Differential diagnosis

Axilliary abscess

  •   Collection of pus and infected material in or on the skin.
  •   Affects all ages.
  •   Open sore or closed, domed nodule.
  •   Has a red appearance, may discharge pus.
  •   Localised swelling, induration (hardening of tissue).
  •   Fever or rigors.

Contributed by Dr Vasa Gnanapragasam, GP in Sutton, Surrey

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