Skin nontumor
Infectious disorders
Hidradenitis suppurativa

Topic Completed: 1 December 2010

Minor changes: 16 November 2020

Copyright: 2002-2021,, Inc.

PubMed Search: Hidradenitis suppurativa [title]

Mowafak Hamodat, M.B.Ch.B., M.Sc.
Page views in 2020: 11,875
Page views in 2021 to date: 2,518
Cite this page: Hamodat M. Hidradenitis suppurativa. website. Accessed March 6th, 2021.
Definition / general
  • A chronic, relapsing, suppurative inflammation of the terminal hair follicle in areas of apocrine glands: axilla, inguinal folds, perineum, genitalia and periareolar region
  • Suggested to called disease acne inversa because first pathogenetic change is in the pilosebaceous follicular ducts, like acne
  • Also called Verneuil disease
  • Due to bacterial infection around apocrine glands of axilla, occasionally perineum or vulva
  • Usually due to anaerobes, which cause an offensive smell
  • Staphylococcus aureus, Strep Viridans and E. coli are also involved
  • Associated with cigarette smoking (Dermatology 1999;198:261) and obesity
Clinical features
  • Initially is a painful nodule of groin or axilla that may involute slowly or produce a foul smelling discharge (due to anaerobes)
  • May produce abscess, fistula and scarring
  • Late changes are a complex interconnecting system of sinuses extending deeply into the dermis and subcutaneous fat with extensive dense fibrosis
  • Patients have increased risk of squamous cell cancinoma of skin, usually men with chronic disease of anogenital region, tumors are HPV related (Dermatology 2010;220:147)
  • Staged with Hurley staging system (Int J Med Sci 2010; 7: 240)
Clinical images

Images hosted on other servers:


Gross description
  • Abscesses, sinuses, perianal fistulas with scarring
Microscopic (histologic) description
  • Heavy neutrophilic or mixed inflammatory infiltrate around apocrine glands with dilated lumina
  • Sinus tracts with marked suppuration and frank abscess formation; sinuses are lined by a mixture of granulation tissue and squamous epithelium, which extends from the associated follicular epithelium
  • The inflammatory sinus tracts contain desquamated keratin and sometimes hair shafts, and are surrounded by dense fibrosis
  • Suppuration may extend into adjacent connective tissue, where there may be a foreign body type reaction of histiocytes and giant cells due to the keratin
  • Hyperkeratosis of the terminal follicles (89%), subepidermal cellular inflammatory infiltrate (82%), hyperplasia of follicular epithelium (80%), pronounced perifolliculitis (68%), epidermal psoriasiform hyperplasia (56%), involvement of apocrine glands (52%), involvement of subcutis (31%), follicle rupture (24%) (Br J Dermal 2011;164:367)
Microscopic (histologic) images

Images hosted on other servers:

Fistula in axilla

Additional references
Back to top
Image 01 Image 02