www.surgicalnotes.co.uk

Pathology

1. Hidarenitis suppurativa
   • Chronic recurrent infection of apocrine sweat glands
   • Thought to be antigen-antibody reaction with blockage of follicular secretions
   • Abcesses form recurrently and causes characteristic permanent disfiguration of the skin
2. Usually affects young women
3. Prevalence 0.3-0.4% in industrialised countries

Approach

• Examine as for any lump

1. Inspect
   • Skin thickened and may ulcerate
   • "watering can" sinuses may be seen
   • Look for signs of activa current infection (tenderness / increased temperature / erythema)
2. Palpate
   • Tenderrness
   • Temperature
   • Draining lymph nodes

Completion

1. Ask about symptoms arising from the condition - how it affects life
2. Any other affected areas - groin, perineum
3. Predisposing factors - diabetes

Treatment

1. Well-localised abscess
   • incision and drainage under antibiotic cover
2. Large lesion
   
   • radical excision and full-thickness skin graft usually harvested from groin or abdomen