Hidradenitis Suppurativa

I. Definisi
Hidradenitis suppurativa merupakan penyakit peradangan kronik supuratif yang berasal dari kelenjar apokrin.
Tempat predileksinya didaerah aksila, anogenital dan jarang dikulit kepala (cicatrizing perifolliculitis).
Berhubungan dengan severe nodulocystic acne dan pilonidal sinses (follicular occlusion syndrome).
Sinonim : apocrinitis, hidradenitis axillaris, abscess kelenjar keringat apokrin.
II. Epidemiology
Penyakit ini dilaporkan lebih sering pada perempuan. Pada pria predileksi cenderung di anogenital dan pada
wanita di axilla. Kejadian terbanyak pada masa pubertas sampai dewasa muda dan masa klimaterik. Berdasarkan
ras, penyakit ini terjadi pada semua ras. Pada pasien yang mengalami hidradenitis supurativa ditemukan pada
keluarganya terdapat riwayat nodulocystic acne dan hidradenitis suppurativa.
III. Etiology and Pathogenesis
Predispopsisi : obesitas, genetic predisposition to acne, obstruksi kelenjar apokrin, secondary bacterial infeksi.
IV. Pathogenesis
Keratinous plugging of the apocrine duct dan hair follicle  inflammatory changes hanya pada satu kelenjar
apokrin  pertumbuhan bakteri di kelenjar yang melebar  robeknya duktus atau kelenjar menyebabkan
penyebaran inflamasi / infeksi  ekstensi suppuration / tissue destruction  ulserasi dan fibrosis, pembentukan
sinus tract.
V. History
Intermittent pain dan adanya nyeri tekan pada pembentukan abses di aksila dan atau anogenital area.
VI. Physical Examination
Skin lesions
Initial lesion : nyeri tekan, nodul/abses yang merah yang bisa resolve or drain purulent/seropurulent material.
Lesi yang sama bisa muncul lagi di lokasi yang sama. Open comedones and at times unique double comedones,
are highly characteristic of the disease and may be present even when active nodules are absent. Eventually,
sinus tracts may form lesions moderately to exquisitely tender. Pus mengalir dari opening abscess dan sinus
tracts. Fibrosis, “bridge” scars, hypertrophic and keloidal scars, contractures. Rarely, lymphedema of associated
limb may develop.
Distribution : axxilae, breasts, anogenital area, groin. Bilateral in axillae and/or anogenital area; may extend over
entire back buttocks and scalp
Associated findings : cystic acne, pilonidal sinus. Often obesity.
VII. Laboratory Examinations
Bacteriology : various pathogens may secondarily colonize or “infect” lesions. These include S.aureus,
streptococci, Escherichia coli, Proteus mirabilis dan Pseudomonas aerugonosa.
Dermatopathology
Early : keratin occlusion of apocrine duct and hair follicle, ductal/tuular dilatation, inflammatory changes limited
to a single apocrine gland. Late: destruction of apocrine/eccrine/pilosebaceous apparatus, fibrosis,
pseudoepitheliomatous hyperplasi in sinuses.
VIII. Differential Diagnosis
Painful papule, nodule, abscess in groin and axilla. Early : furuncle, carbuncle, lymphadenitis, ruptured inclusion
cyst, cat scratch disease. Late: lymphogranuloma venereum, donovanosis, scrofuloderma, actinomycosis, sinus
tracts and fistulas associated with ulcerative colitis and regional enteritis.
IX. Course and Prognosis
Many patiens have only mild involvement with recurrent, self healing, tender red nodules and do not seek
therapy. Disease biasanya spontaneous remission with age >35 tahun. Pada beberapa individu, course can be
relentlessly progressive, with marked morbidity related to chronic pain, draining sinuses and scarring with
restricted mobility. Complication (rare0 fistula to urethre, bladder and/or rectum; anemia, amyloidosis.
X. Management
Intralesional glucocorticoids, surgery, oral antibiotic, isotretinoin.

Medical management
Acute painful lesions.
Nodule Intralesional triamcinolone (3-5 mg/mL).
Abscess : intralesional triamcinolone (3-5 mg/mL) into the wall followed by incision and drainage of abscess fluid.
Chronic low grade disease
Oral antibiotics : erythromycin (250-500 mg qid), tetracycline (250-500 mg qid), or minocycline (100 bis) until
lesions resolve; may take weeks. Intralesional triamcinolone (3-5 mg/mL) into early inflammatory lesions helpful
hastening resolution of individual lesions.
Prednisone : may be given concurrently if pain and inflammation are severe : 70 mg daily for 2-3 days, tapered
over 14 days.
Oral isotretinoin : no useful in severe disease but appears to be useful in early diseaseand when combined with
surgical excision of individual lesions.

Surgical management
- Incise and drain acute abscesses.
- Excise chronic recurrent, fibrotic nodules in sinus tracts.
- With extensive, chronic disease, complete excision of axilla or involved anogenital area may be required.
Excision should extend down to fascia and required split skin grafting.

Psychologic management

Need constant reassurance, they become very depressed because of nature of the illness, e.g. pain, soiling of
clothing by draining pus, odor, site of occurrence (anogenital area)

XI.